Healthcare Provider Details

I. General information

NPI: 1386655793
Provider Name (Legal Business Name): RALPH CASEY EDWARDS PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N OWEN WALTERS BLVD
SALINA OK
74365-5003
US

IV. Provider business mailing address

PO BOX 1663
SALLISAW OK
74955-1663
US

V. Phone/Fax

Practice location:
  • Phone: 918-434-8507
  • Fax: 918-434-8587
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13680
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: