Healthcare Provider Details

I. General information

NPI: 1376810952
Provider Name (Legal Business Name): MR. CURTIS J EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2011
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E SAUK TRL
SAUK VILLAGE IL
60411-5262
US

IV. Provider business mailing address

1520 THORNHILL DR
SCHERERVILLE IN
46375-1597
US

V. Phone/Fax

Practice location:
  • Phone: 708-757-6906
  • Fax: 708-757-7867
Mailing address:
  • Phone: 219-865-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-035260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: