Provider Demographics
NPI:1396067385
Name:EDR GROUP INC
Entity type:Organization
Organization Name:EDR GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZZAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-4040
Mailing Address - Street 1:10806 US HIGHWAY 19
Mailing Address - Street 2:STE 105
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-2563
Mailing Address - Country:US
Mailing Address - Phone:727-868-4040
Mailing Address - Fax:727-868-4077
Practice Address - Street 1:10806 US HIGHWAY 19
Practice Address - Street 2:STE 105
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2563
Practice Address - Country:US
Practice Address - Phone:727-868-4040
Practice Address - Fax:727-868-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24470333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1054395OtherNCPDP PROVIDER IDENTIFICATION NUMBER