Provider Demographics
NPI:1124919782
Name:MULDROW, EDWIN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:MULDROW
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2026
Mailing Address - Country:US
Mailing Address - Phone:773-762-5058
Mailing Address - Fax:773-762-4925
Practice Address - Street 1:3726 W 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2026
Practice Address - Country:US
Practice Address - Phone:773-762-5058
Practice Address - Fax:773-762-4925
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.039643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist