Provider Demographics
NPI:1215528948
Name:EDWARDS, CHRISTOPHER RON (CPCT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CPCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43957 TIMBERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3292
Mailing Address - Country:US
Mailing Address - Phone:313-585-3700
Mailing Address - Fax:
Practice Address - Street 1:43957 TIMBERVIEW CT
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-3292
Practice Address - Country:US
Practice Address - Phone:313-585-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183700000X, 347C00000X
MI5303018960183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No347C00000XTransportation ServicesPrivate Vehicle