Provider Demographics
NPI:1730470170
Name:PRATER, EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:PRATER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 KIM KENT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2901
Mailing Address - Country:US
Mailing Address - Phone:859-623-5812
Mailing Address - Fax:859-624-4350
Practice Address - Street 1:1115 KIM KENT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2901
Practice Address - Country:US
Practice Address - Phone:859-623-5812
Practice Address - Fax:859-624-4350
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist