Provider Demographics
NPI:1730495391
Name:EDWARDS, KEVIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 E CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1424
Mailing Address - Country:US
Mailing Address - Phone:719-440-4955
Mailing Address - Fax:
Practice Address - Street 1:2955 E CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1424
Practice Address - Country:US
Practice Address - Phone:719-440-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011465183500000X
CA812175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No175F00000XOther Service ProvidersNaturopath