Healthcare Provider Details

I. General information

NPI: 1922095108
Provider Name (Legal Business Name): CAROL ANN BEDINGHAUS R PH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 N COLLIER BLVD
MARCO ISLAND FL
34145-2555
US

IV. Provider business mailing address

1531 NAUTILUS RD
NAPLES FL
34102-5153
US

V. Phone/Fax

Practice location:
  • Phone: 239-394-3111
  • Fax: 239-394-8841
Mailing address:
  • Phone: 239-263-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: