Provider Demographics
NPI:1013102060
Name:EDGIN, GREGORY LEON (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEON
Last Name:EDGIN
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 1:640 HIGHWAY 114 S
Mailing Address - Street 2:
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-5023
Mailing Address - Country:US
Mailing Address - Phone:731-549-3927
Mailing Address - Fax:731-549-2323
Practice Address - Street 1:640 HIGHWAY 114 S
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-5023
Practice Address - Country:US
Practice Address - Phone:731-549-3927
Practice Address - Fax:731-549-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist