Healthcare Provider Details

I. General information

NPI: 1285612531
Provider Name (Legal Business Name): EDWARD LEWIS EMDE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIOWA DR W #104
LAKE KIOWA TX
76240-9506
US

IV. Provider business mailing address

403 ASHLAND DR
GAINESVILLE TX
76240-4514
US

V. Phone/Fax

Practice location:
  • Phone: 940-668-7384
  • Fax: 940-665-8859
Mailing address:
  • Phone: 940-665-0297
  • Fax: 940-665-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: