MEDICARE: DR. MICHAEL ALLEN EDDY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-13105	KS

General Provider Information

NPI Number	:	1598065112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALLEN EDDY PHARMD

Provider Business Mailing Address
First Line	:	520 W BERTRAND AVE
Second Line	:
City	:	SAINT MARYS
State	:	KS
Zip	:	66536-1695
Country	:	US
Telephone Number	:	785-437-2967
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 W BERTRAND AVE
Second Line	:
City	:	SAINT MARYS
State	:	KS
Zip	:	66536-1695
Country	:	US
Telephone Number	:	785-437-2967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	04/15/2014

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