Provider Demographics
NPI:1891270948
Name:EDWARDS, MELODY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:A
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:US ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:BLUEWELL
Mailing Address - State:WV
Mailing Address - Zip Code:24701
Mailing Address - Country:US
Mailing Address - Phone:304-589-7732
Mailing Address - Fax:
Practice Address - Street 1:US ROUTE 52
Practice Address - Street 2:
Practice Address - City:BLUEWELL
Practice Address - State:WV
Practice Address - Zip Code:24701
Practice Address - Country:US
Practice Address - Phone:304-589-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist