Provider Demographics
NPI:1255951513
Name:EDWARDS, DELEA DAWN (CPHT)
Entity type:Individual
Prefix:MS
First Name:DELEA
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6435
Mailing Address - Country:US
Mailing Address - Phone:276-237-3427
Mailing Address - Fax:
Practice Address - Street 1:165 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6435
Practice Address - Country:US
Practice Address - Phone:276-237-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230028668183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician