Healthcare Provider Details

I. General information

NPI: 1326758830
Provider Name (Legal Business Name): ADDISON LYNN BEDWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 WATER TOWER PL
ARNOLD MO
63010-2142
US

IV. Provider business mailing address

1253 WATER TOWER PL
ARNOLD MO
63010-2142
US

V. Phone/Fax

Practice location:
  • Phone: 636-282-0591
  • Fax: 636-282-0816
Mailing address:
  • Phone: 636-282-0591
  • Fax: 636-282-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022030077
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: