Provider Demographics
NPI:1396153011
Name:MUDER, EDWARD KRAIG (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:KRAIG
Last Name:MUDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-3011
Mailing Address - Country:US
Mailing Address - Phone:928-242-7960
Mailing Address - Fax:
Practice Address - Street 1:750 W DEUCE OF CLUBS
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5810
Practice Address - Country:US
Practice Address - Phone:928-537-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist