Healthcare Provider Details

I. General information

NPI: 1598473936
Provider Name (Legal Business Name): EARL EDWARD ESKRIDGE IV PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

19 AUGUSTA CT W
HATTIESBURG MS
39402-7657
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.021813
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: