Provider Demographics
NPI:1649565037
Name:EDWARDS, THOMAS ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ADAM
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 HANES MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5526
Mailing Address - Country:US
Mailing Address - Phone:336-768-2888
Mailing Address - Fax:336-760-2591
Practice Address - Street 1:855 HANES MALL BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5526
Practice Address - Country:US
Practice Address - Phone:336-768-2888
Practice Address - Fax:336-760-2591
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist