Provider Demographics
NPI:1801938063
Name:EDWARDS, ULLI (RPH)
Entity type:Individual
Prefix:
First Name:ULLI
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ULLI
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:15608 SPRING HILL LN STE 114
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3320
Mailing Address - Country:US
Mailing Address - Phone:512-990-5226
Mailing Address - Fax:512-251-5762
Practice Address - Street 1:15608 SPRING HILL LN STE 114
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3320
Practice Address - Country:US
Practice Address - Phone:512-990-5226
Practice Address - Fax:512-251-5762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143608Medicaid