Healthcare Provider Details

I. General information

NPI: 1851388581
Provider Name (Legal Business Name): EDMUND OTIS WALDEN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD PHARMACY SERVICE (119)
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

PO BOX 37
HIGH SPRINGS FL
32655-0037
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-4029
Mailing address:
  • Phone: 386-454-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0016175
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS0016175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: