MEDICARE: EDGEWOOD DRUG INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	6782	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2102565	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972687614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGEWOOD DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 659
Second Line	:
City	:	EDGEWOOD
State	:	TX
Zip	:	75117-0659
Country	:	US
Telephone Number	:	903-986-1473
Fax Number	:	903-896-1481

Provider Business Practice Location Address
First Line	:	115 N HOUSTON ST
Second Line	:
City	:	EDGEWOOD
State	:	TX
Zip	:	75117-2502
Country	:	US
Telephone Number	:	903-896-1473
Fax Number	:	903-896-1481

Authorized Official
Title or Position	:	OWNER
Name	:	TAMI CRAWFORD
Credential	:	R.PH
Telephone Number	:	903-896-1473

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/28/2017

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Directions to “EDGEWOOD DRUG INC ” Practice Location

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