Provider Demographics
NPI:1861787293
Name:EDWARDS, ANNE RASMUSSEN (RPH)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:RASMUSSEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 HIGHWAY 365 STE 90
Mailing Address - Street 2:T1877
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7796
Mailing Address - Country:US
Mailing Address - Phone:409-729-3379
Mailing Address - Fax:409-729-3379
Practice Address - Street 1:3100 HIGHWAY 365 STE 90
Practice Address - Street 2:T1877
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7796
Practice Address - Country:US
Practice Address - Phone:409-729-3379
Practice Address - Fax:409-729-3379
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist