Provider Demographics
NPI:1538164033
Name:BEDWICK'S PHARMACY INC
Entity type:Organization
Organization Name:BEDWICK'S PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-823-3818
Mailing Address - Street 1:452 HAZLE ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4627
Mailing Address - Country:US
Mailing Address - Phone:570-823-3818
Mailing Address - Fax:570-825-6189
Practice Address - Street 1:452 HAZLE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-4627
Practice Address - Country:US
Practice Address - Phone:570-823-3818
Practice Address - Fax:570-825-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412380L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001720670Medicaid
2080985OtherPK
PA001720670Medicaid