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General NPI Number Information
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NPI Number | 1821300419
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Entity Type | Individual
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Provider Name | EDWARD STANLEY EDMUNDSON III RPH
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 419 W BROAD ST
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City | SAINT PAULS
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State | NC
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Zip | 28384-1537
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Country | US
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Telephone | 910-865-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 4176 ENGLISH GARDEN WAY
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City | RALEIGH
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State | NC
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Zip | 27612-4351
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Country | US
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Telephone | 919-571-1889
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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 | 6263
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License Number State | NC
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