Provider Demographics
NPI:1285725309
Name:EDWARDS, JOHN EDMUND (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDMUND
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHURCH STREET
Mailing Address - Street 2:GEISINGER SOUTH WILKES BARRE
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18765
Mailing Address - Country:US
Mailing Address - Phone:570-830-8861
Mailing Address - Fax:570-831-8967
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:GEISINGER SOUTH WILKES BARRE
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18765
Practice Address - Country:US
Practice Address - Phone:570-830-8861
Practice Address - Fax:570-831-8967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035294L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy