Healthcare Provider Details

I. General information

NPI: 1013102060
Provider Name (Legal Business Name): GREGORY LEON EDGIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 HIGHWAY 114 S
SCOTTS HILL TN
38374-5023
US

IV. Provider business mailing address

640 HIGHWAY 114 S
SCOTTS HILL TN
38374-5023
US

V. Phone/Fax

Practice location:
  • Phone: 731-549-3927
  • Fax: 731-549-2323
Mailing address:
  • Phone: 731-549-3927
  • Fax: 731-549-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6905
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: