Healthcare Provider Details

I. General information

NPI: 1649500570
Provider Name (Legal Business Name): ISLEN D EDWARDS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

62 FIELDCREST DRIVE
WESTAMPTON NJ
08060
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3102
  • Fax:
Mailing address:
  • Phone: 954-854-6026
  • Fax: 609-877-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number32297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: