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General NPI Number Information
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NPI Number | 1265431852
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Entity Type | Individual
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Provider Name | CATHLEEN MARIE EDICK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 850 76TH ST SW MAILCODE: GR761120
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City | GRAND RAPIDS
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State | MI
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Zip | 49518-8700
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Country | US
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Telephone | 616-878-2324
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Fax | 616-878-8850
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Provider Business Mailing Address
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Address Line | 850 76TH ST SW MAILCODE: GR761120
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City | GRAND RAPIDS
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State | MI
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Zip | 49518-8700
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Country | US
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Telephone | 616-878-2324
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Fax | 616-878-8850
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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 | 5302034435
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11655
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License Number State | TN
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