Healthcare Provider Details

I. General information

NPI: 1063199792
Provider Name (Legal Business Name): NICHOLAS BEDWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COLE BEDWELL PHARMD

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 LOVERS LN
BOWLING GREEN KY
42103-7199
US

IV. Provider business mailing address

1122 LOVERS LN
BOWLING GREEN KY
42103-7199
US

V. Phone/Fax

Practice location:
  • Phone: 270-842-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023543
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: