MEDICARE: DR. NEIL LUCAS EDLEN PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	P1779	NC

General Provider Information

NPI Number	:	1598066466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL LUCAS EDLEN PHARMD.

Provider Business Mailing Address
First Line	:	PO BOX 6713
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-6713
Country	:	US
Telephone Number	:	850-776-3804
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 N SOUTH ST
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3532
Country	:	US
Telephone Number	:	850-776-3804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	07/06/2021

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