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General NPI Number Information
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NPI Number | 1316543986
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Entity Type | Individual
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Provider Name | MORDECHAI EDERY
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Gender | Male
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1350 N WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75211-1654
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Country | US
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Telephone | 214-689-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 RIVER BEND DR STE 200
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City | DALLAS
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State | TX
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Zip | 75247-6945
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Country | US
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Telephone | 214-743-6180
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Fax | 214-905-7537
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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 | 27340
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License Number State | TX
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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 | PH18901
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License Number State | MA
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