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General NPI Number Information
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NPI Number | 1568450914
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Entity Type | Individual
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Provider Name | EDWARD K GIFFORD R.PH
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 362 COFFEEN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-4809
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Country | US
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Telephone | 307-672-7705
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Fax | 307-672-7705
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Provider Business Mailing Address
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Address Line | 1030 5TH AVE E
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City | SHERIDAN
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State | WY
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Zip | 82801-6229
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Country | US
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Telephone | 307-672-7705
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Fax | 307-672-7705
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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 | 1835N1003X
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Taxonomy Name | Nutrition Support Pharmacist
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License Number | 2569
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License Number State | WY
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