Edgewood Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

6782 Issued in TX

Legal business name

EDGEWOOD DRUG INC

Doing business as

Edgewood Legend Drug

Practice address

115 N Houston St
Edgewood, TX 75117-2502

Phone

(903) 896-1473

Fax

(903) 896-1481

NPI assigned

Oct 25, 2006

Last updated

Feb 28, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tami Crawford, R.PH

Title

Owner

Phone

(903) 896-1473

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• EDGEWOOD LEGEND DRUG Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1972687614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 659",
            "city": "EDGEWOOD",
            "state": "TX",
            "postal_code": "751170659",
            "telephone_number": "903-986-1473",
            "fax_number": "903-896-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N HOUSTON ST",
            "city": "EDGEWOOD",
            "state": "TX",
            "postal_code": "751172502",
            "telephone_number": "903-896-1473",
            "fax_number": "903-896-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-896-1473",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "6782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2102565",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142867",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGEWOOD LEGEND DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Chapmond, LCDC
• Yvonne Carol Dixon, LVN
• Tiffany Dunn, MS,CCC/SLP
• East Texas Out-Patient PLLC
• East Texas Pediatric Therapy
• Edgewood Isd
• Edgewood Rural Healthh Clinic
• Gober LLC (East Texas Pediatric Therapy)
• Edith Head, PT
• Julie Ann Higginbotham, MSN, RN

• Community/Retail Pharmacy in Edgewood, TX
• Providers in Edgewood, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.