Provider Demographics
NPI:1427644616
Name:EDEBIRI, AIREN
Entity type:Individual
Prefix:
First Name:AIREN
Middle Name:
Last Name:EDEBIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 RUGER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3218
Mailing Address - Country:US
Mailing Address - Phone:214-418-1350
Mailing Address - Fax:
Practice Address - Street 1:9075 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-6742
Practice Address - Country:US
Practice Address - Phone:214-387-3094
Practice Address - Fax:214-387-0854
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist