Provider Demographics
NPI:1659653129
Name:LEVY, EDWARD KARL (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KARL
Last Name:LEVY
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 1:250 RIDGEDALE AVE
Mailing Address - Street 2:UNIT R8
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1319
Mailing Address - Country:US
Mailing Address - Phone:201-738-3258
Mailing Address - Fax:973-410-9345
Practice Address - Street 1:431 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1555
Practice Address - Country:US
Practice Address - Phone:973-904-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI013943001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist