Provider Demographics
NPI:1790038552
Name:EDEBIRI, VERA O (RPH)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:O
Last Name:EDEBIRI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E 14TH ST
Mailing Address - Street 2:404
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4423
Mailing Address - Country:US
Mailing Address - Phone:972-897-8445
Mailing Address - Fax:
Practice Address - Street 1:3200 E 14TH ST
Practice Address - Street 2:404
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4423
Practice Address - Country:US
Practice Address - Phone:972-897-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist