Provider Demographics
NPI:1063748408
Name:EDWARDS, CARL GENE JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:GENE
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S BRIGHT LEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577
Mailing Address - Country:US
Mailing Address - Phone:919-934-7164
Mailing Address - Fax:919-934-0921
Practice Address - Street 1:840 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4377
Practice Address - Country:US
Practice Address - Phone:919-934-7164
Practice Address - Fax:919-934-0921
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0515296Medicaid
1078450001Medicare NSC