Provider Demographics
NPI:1285800060
Name:EDWARDS, PATRICIA ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MOWBRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1979 S DERBY RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48885-9753
Mailing Address - Country:US
Mailing Address - Phone:616-232-5267
Mailing Address - Fax:
Practice Address - Street 1:838 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1054
Practice Address - Country:US
Practice Address - Phone:616-374-3190
Practice Address - Fax:616-374-9120
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist