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General NPI Number Information
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NPI Number | 1699302786
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Entity Type | Individual
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Provider Name | LEAH BETHANY EDENFIELD PHARMD, BCOP, CPP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | MEDICAL CENTER BOULEVARD
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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Country | US
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Telephone | 336-713-9867
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Fax | 336-713-9858
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Provider Business Mailing Address
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Address Line | 1315 CREEKSHIRE WAY APT 220
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3096
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Country | US
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Telephone | 757-651-3344
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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 | 25391
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License Number State | NC
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