MEDICARE: DERRON EDISON

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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1841185139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRON EDISON

Provider Business Mailing Address
First Line	:	3050 MODELLA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 MODELLA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2429
Country	:	US
Telephone Number	:	907-947-5442
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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Directions to “ DERRON EDISON ” Practice Location

Language	Start Address	Practice Location

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