Provider Demographics
NPI:1487051041
Name:LABBAN, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LABBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 CONWAY PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7988
Mailing Address - Country:US
Mailing Address - Phone:310-721-7508
Mailing Address - Fax:
Practice Address - Street 1:4311 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-8814
Practice Address - Country:US
Practice Address - Phone:310-821-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS68166183500000X
CARPH70686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist