Healthcare Provider Details

I. General information

NPI: 1013385152
Provider Name (Legal Business Name): BIBIDH SUBEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

7542 ACE RD S
LAKE WORTH FL
33467-3144
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1495
  • Fax:
Mailing address:
  • Phone: 561-827-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028746
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: