Provider Demographics
NPI:1780974733
Name:CANARY, EDWARD L II
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:CANARY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4021
Mailing Address - Country:US
Mailing Address - Phone:502-968-7777
Mailing Address - Fax:502-939-9328
Practice Address - Street 1:7700 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4021
Practice Address - Country:US
Practice Address - Phone:502-968-7777
Practice Address - Fax:502-939-9328
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY08181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist