Provider Demographics
NPI:1982999876
Name:EDWARDS, CURTIS JON (PHARM D)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:JON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2019
Mailing Address - Country:US
Mailing Address - Phone:623-931-5748
Mailing Address - Fax:623-215-0602
Practice Address - Street 1:10404 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2019
Practice Address - Country:US
Practice Address - Phone:623-931-5748
Practice Address - Fax:623-215-0602
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist