Provider Demographics
NPI:1265431852
Name:EDICK, CATHLEEN MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:MARIE
Last Name:EDICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 76TH ST SW
Mailing Address - Street 2:MAILCODE: GR761120
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49518-8700
Mailing Address - Country:US
Mailing Address - Phone:616-878-2324
Mailing Address - Fax:616-878-8850
Practice Address - Street 1:850 76TH ST SW
Practice Address - Street 2:MAILCODE: GR761120
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49518-8700
Practice Address - Country:US
Practice Address - Phone:616-878-2324
Practice Address - Fax:616-878-8850
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034435183500000X
TN11655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist