Provider Demographics
NPI:1699788075
Name:EDWARDS, JOHN DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 US HIGHWAY 60 E
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2509
Mailing Address - Country:US
Mailing Address - Phone:270-826-5589
Mailing Address - Fax:
Practice Address - Street 1:2448 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2509
Practice Address - Country:US
Practice Address - Phone:270-826-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8943OtherPHARMACY LICENSE