Healthcare Provider Details

I. General information

NPI: 1497974042
Provider Name (Legal Business Name): EDWARD LEO CALLAHAN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W. WALNUT ST.
CARSON CA
90248-3103
US

IV. Provider business mailing address

337 WATERVIEW ST
PLAYA DEL REY CA
90293-8050
US

V. Phone/Fax

Practice location:
  • Phone: 310-515-8425
  • Fax: 310-515-8426
Mailing address:
  • Phone: 310-821-5998
  • Fax: 310-306-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 26227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: