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General NPI Number Information
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NPI Number | 1740097609
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Entity Type | Individual
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Provider Name | HUNTER R EDGE
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Gender | Male
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 301 FISHER ST
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City | BILOXI
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-376-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 POPPS FERRY RD APT M1305
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City | BILOXI
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State | MS
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Zip | 39532-2045
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Country | US
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Telephone | 228-396-2880
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | E-101802
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License Number State | MS
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