Provider Demographics
NPI:1730257916
Name:LANDRY, EDWARD TODD (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:TODD
Last Name:LANDRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3265
Mailing Address - Country:US
Mailing Address - Phone:607-748-7455
Mailing Address - Fax:607-770-0939
Practice Address - Street 1:343 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2017
Practice Address - Country:US
Practice Address - Phone:607-729-2234
Practice Address - Fax:607-770-0939
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist