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General NPI Number Information
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NPI Number | 1417256561
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Entity Type | Individual
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Provider Name | PHILLIP R EDELBLUTE RPH
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Gender | Male
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 2850 CAPITAL BLVD
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City | RALEIGH
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State | NC
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Zip | 27604-2414
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Country | US
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Telephone | 919-421-0413
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Fax |
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Provider Business Mailing Address
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Address Line | 116 MUNFORD DR
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City | LOUISBURG
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State | NC
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Zip | 27549-2175
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Country | US
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Telephone | 919-630-7394
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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 | 19876
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License Number State | NC
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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 | 8410
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License Number State | OK
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