=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598041212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN F EDMUNDSON R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 10/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6918 HAMILTON AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45231-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-931-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11586 ARISTOCRAT DR
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45030-9753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-738-8515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03218229
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26016467A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------