Provider Demographics
NPI:1174602544
Name:ROBERT L. EDWARD
Entity type:Organization
Organization Name:ROBERT L. EDWARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-766-1224
Mailing Address - Street 1:3522 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1339
Mailing Address - Country:US
Mailing Address - Phone:256-766-1224
Mailing Address - Fax:256-766-1235
Practice Address - Street 1:3522 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1339
Practice Address - Country:US
Practice Address - Phone:256-766-1224
Practice Address - Fax:256-766-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL107220333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0123290OtherNABP
AL100002392Medicaid