Provider Demographics
NPI:1821300419
Name:EDMUNDSON, EDWARD STANLEY III (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:STANLEY
Last Name:EDMUNDSON
Suffix:III
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 1:4176 ENGLISH GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4351
Mailing Address - Country:US
Mailing Address - Phone:919-571-1889
Mailing Address - Fax:
Practice Address - Street 1:419 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1537
Practice Address - Country:US
Practice Address - Phone:910-865-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist