Provider Demographics
NPI:1720609357
Name:FAISON, EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:FAISON
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 1:2118 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6718
Mailing Address - Country:US
Mailing Address - Phone:405-740-4488
Mailing Address - Fax:
Practice Address - Street 1:5240 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4004
Practice Address - Country:US
Practice Address - Phone:719-262-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51691183500000X
CO21319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist