Provider Demographics
NPI:1104450501
Name:PFEIFFER, EDWARD PAUL (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:PFEIFFER
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 1:111 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-2603
Mailing Address - Country:US
Mailing Address - Phone:940-495-2335
Mailing Address - Fax:
Practice Address - Street 1:111 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-2603
Practice Address - Country:US
Practice Address - Phone:940-495-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist