Healthcare Provider Details

I. General information

NPI: 1922190180
Provider Name (Legal Business Name): LENA M EDWARDS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 20TH ST
PHILADELPHIA PA
19121-2217
US

IV. Provider business mailing address

500 S BROAD ST
PHILADELPHIA PA
19146-1613
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-2936
  • Fax:
Mailing address:
  • Phone: 215-685-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP037379L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: