Provider Demographics
NPI:1457620080
Name:BECKER, EDWARD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:836 DEERVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2840 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1523
Practice Address - Country:US
Practice Address - Phone:859-781-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist