Provider Demographics
NPI:1770064107
Name:STEIN, EDWARD JUDE (PHARMD, MPH)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JUDE
Last Name:STEIN
Suffix:
Gender:M
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12929 N 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9583
Mailing Address - Country:US
Mailing Address - Phone:623-910-1074
Mailing Address - Fax:
Practice Address - Street 1:TWO RENAISSANCE SQUARE, 40 N CENTRAL AVE
Practice Address - Street 2:SUITE 780, IHS CLINICAL SUPPORT CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-364-7777
Practice Address - Fax:602-364-7788
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist