Provider Demographics
NPI:1821270349
Name:GEDDES, EDSEL O (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDSEL
Middle Name:O
Last Name:GEDDES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4005
Mailing Address - Country:US
Mailing Address - Phone:718-278-2100
Mailing Address - Fax:
Practice Address - Street 1:3287 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4005
Practice Address - Country:US
Practice Address - Phone:718-278-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516321183500000X
NJRI028051183500000X
FLPS35358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist