Healthcare Provider Details

I. General information

NPI: 1770762387
Provider Name (Legal Business Name): JAMES PAUL EDSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 WESTINGHOUSE RD
HORSEHEADS NY
14845-8196
US

IV. Provider business mailing address

2898 WESTINGHOUSE RD
HORSEHEADS NY
14845-8196
US

V. Phone/Fax

Practice location:
  • Phone: 607-796-2673
  • Fax: 607-796-5574
Mailing address:
  • Phone: 607-796-2673
  • Fax: 607-796-5574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: