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NPI Code Detail

MEDICARE: DR. DUSTIN TODD EDGE PHARMD

MEDICARE: DR. DUSTIN TODD EDGE 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
1183500000XPharmacist21077NC

General Provider Information

NPI Number : 1932417292
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUSTIN TODD EDGE PHARMD
Provider Business Mailing Address
First Line : 2336 CLEVELAND AVE
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28312-9203
Country : US
Telephone Number : 910-624-2978
Fax Number :
Provider Business Practice Location Address
First Line : 4923 RAEFORD RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3141
Country : US
Telephone Number : 910-423-1251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2010
Last Update Date : 09/21/2010

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Directions to “ DR. DUSTIN TODD EDGE PHARMD” Practice Location

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