Provider Demographics
NPI:1851744619
Name:EDWARDS, HYUN
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 N KROCKS RD
Mailing Address - Street 2:COSTCO PHARMACY
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9046
Mailing Address - Country:US
Mailing Address - Phone:484-273-7066
Mailing Address - Fax:484-273-7057
Practice Address - Street 1:791 N KROCKS RD
Practice Address - Street 2:COSTCO PHARMACY
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9046
Practice Address - Country:US
Practice Address - Phone:484-273-7066
Practice Address - Fax:484-273-7057
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP450635OtherPHARMACIST LICENSE
PARPI010614OtherAUTHORIZATION TO ADMINISTER INJECTABLES