Provider Demographics
NPI:1154732998
Name:EDINGTON, STEWART
Entity type:Individual
Prefix:MR
First Name:STEWART
Middle Name:
Last Name:EDINGTON
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 1:61 VIA CARTAYA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6514
Mailing Address - Country:US
Mailing Address - Phone:954-818-6813
Mailing Address - Fax:
Practice Address - Street 1:23665 MOULTON PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1937
Practice Address - Country:US
Practice Address - Phone:949-586-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist