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General NPI Number Information
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NPI Number | 1396067385
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Entity Type | Organization
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Legal Business Name | EDR GROUP INC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 10806 US HIGHWAY 19 STE 105
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City | PORT RICHEY
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State | FL
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Zip | 34668-2563
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Country | US
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Telephone | 727-868-4040
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Fax | 727-868-4077
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Provider Business Mailing Address
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Address Line | 10806 US HIGHWAY 19 STE 105
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City | PORT RICHEY
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State | FL
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Zip | 34668-2563
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Country | US
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Telephone | 727-868-4040
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Fax | 727-868-4077
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | EZZAT ATALLA
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Credential |
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Telephone | 727-868-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH24470
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License Number State | FL
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