Healthcare Provider Details

I. General information

NPI: 1417298019
Provider Name (Legal Business Name): CHAD ALLEN EDGAR PHARM.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST INPATIENT PHARMACY
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST INPATIENT PHARMACY
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5132
  • Fax: 954-985-2207
Mailing address:
  • Phone: 954-265-5132
  • Fax: 954-985-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS40196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: