Healthcare Provider Details

I. General information

NPI: 1326150293
Provider Name (Legal Business Name): CHARLES H BEDGOOD PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 EASTERN BLVD
MONTGOMERY AL
36116-7308
US

IV. Provider business mailing address

380 HILLABEE DR
MONTGOMERY AL
36117-4119
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-6511
  • Fax: 334-284-6388
Mailing address:
  • Phone: 334-277-5116
  • Fax: 334-284-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6903
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: