Healthcare Provider Details

I. General information

NPI: 1003912304
Provider Name (Legal Business Name): BEDINGFIELD PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/23/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 N MAIN ST
PEMBROKE GA
31321
US

IV. Provider business mailing address

27 N MAIN ST PO BOX 326
PEMBROKE GA
31321
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-4596
  • Fax: 912-653-4585
Mailing address:
  • Phone: 912-653-4596
  • Fax: 912-653-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00021832B
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02833
License Number StateGA

VIII. Authorized Official

Name: TERESA F SMITH
Title or Position: CHIEF PHARMACIST
Credential: RPH
Phone: 912-653-4596