Healthcare Provider Details

I. General information

NPI: 1891830915
Provider Name (Legal Business Name): GINA GEORGETTE EDWARDS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N ASH ST
HILLSBORO KS
67063-1102
US

IV. Provider business mailing address

323 N BIRCH ST
HILLSBORO KS
67063-1134
US

V. Phone/Fax

Practice location:
  • Phone: 620-947-3784
  • Fax: 620-947-2801
Mailing address:
  • Phone: 620-947-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-12854
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: