Healthcare Provider Details

I. General information

NPI: 1215528948
Provider Name (Legal Business Name): CHRISTOPHER RON EDWARDS CPCT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43957 TIMBERVIEW CT
VAN BUREN TWP MI
48111-3292
US

IV. Provider business mailing address

43957 TIMBERVIEW CT
VAN BUREN TWP MI
48111-3292
US

V. Phone/Fax

Practice location:
  • Phone: 313-585-3700
  • Fax:
Mailing address:
  • Phone: 313-585-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303018960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: