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General NPI Number Information
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NPI Number | 1154893154
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Entity Type | Individual
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Provider Name | GREGORY EDWARDS
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Gender | Male
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 800 IRVING AVE
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City | SYRACUSE
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State | NY
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Zip | 13210-2716
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Country | US
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Telephone | 315-425-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MALLARD BAY
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City | CHITTENANGO
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State | NY
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Zip | 13037-4130
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Country | US
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Telephone | 315-569-8391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 047544-1
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License Number State | NY
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