Provider Demographics
NPI:1295742674
Name:EDWARDS, MARK S (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:EDWARDS
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 1:108 LAKE POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3821
Mailing Address - Country:US
Mailing Address - Phone:859-623-2738
Mailing Address - Fax:859-625-9386
Practice Address - Street 1:108 LAKE POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3821
Practice Address - Country:US
Practice Address - Phone:859-623-2738
Practice Address - Fax:859-623-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist