Provider Demographics
NPI:1780477638
Name:WEDGEWOOD PHARMACY LLC
Entity type:Organization
Organization Name:WEDGEWOOD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL-ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-307-7154
Mailing Address - Street 1:405 HERON DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:800-331-8272
Mailing Address - Fax:866-646-2235
Practice Address - Street 1:1680 EAST NORTHROP BOULEVARD
Practice Address - Street 2:UNIT #5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:800-331-8272
Practice Address - Fax:866-646-2235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEDGEWOOD PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy