Healthcare Provider Details

I. General information

NPI: 1821270349
Provider Name (Legal Business Name): EDSEL O GEDDES R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3287 STEINWAY ST
ASTORIA NY
11103-4005
US

IV. Provider business mailing address

3287 STEINWAY ST
ASTORIA NY
11103-4005
US

V. Phone/Fax

Practice location:
  • Phone: 718-278-2100
  • Fax:
Mailing address:
  • Phone: 718-278-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0516321
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI028051
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS35358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: