Individual
LARRY EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
208 S WEST ST, WAUPUN, WI 53963-1681
(920) 324-1600
Mailing address
96 KESSEL CT, #35, MADISON, WI 53711-6254
(414) 690-6310
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
734740
WI
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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