Healthcare Provider Details

I. General information

NPI: 1982999876
Provider Name (Legal Business Name): CURTIS JON EDWARDS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 06/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10404 N 43RD AVE
GLENDALE AZ
85302-2019
US

IV. Provider business mailing address

10404 N 43RD AVE
GLENDALE AZ
85302-2019
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-5748
  • Fax: 623-215-0602
Mailing address:
  • Phone: 623-931-5748
  • Fax: 623-215-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS017411
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: