Provider Demographics
NPI:1447445739
Name:EDWARDS, CAROLINE PETER (RPH)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:PETER
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:JUNE
Other - Last Name:PETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:710 FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3911
Mailing Address - Country:US
Mailing Address - Phone:919-530-8774
Mailing Address - Fax:919-530-8814
Practice Address - Street 1:204 LIBERTY PLAZA
Practice Address - Street 2:WEST SWANNANOA AVENUE
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298
Practice Address - Country:US
Practice Address - Phone:336-622-1444
Practice Address - Fax:336-622-7299
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13557OtherLICENSE