Healthcare Provider Details

I. General information

NPI: 1194253062
Provider Name (Legal Business Name): AMBER BEDNARZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N. MAIN ST. STOP AND SHOP PHARMACY
SOUTHINGTON CT
06489-0648
US

IV. Provider business mailing address

44 WINTER PARK RD
SOUTHINGTON CT
06489-4330
US

V. Phone/Fax

Practice location:
  • Phone: 860-620-9060
  • Fax:
Mailing address:
  • Phone: 860-620-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT0010995
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: