Healthcare Provider Details

I. General information

NPI: 1376881326
Provider Name (Legal Business Name): JERRELL STEPHEN BEDFORD JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 S CHURCH ST
FOREST CITY NC
28043-3941
US

IV. Provider business mailing address

756 S CHURCH ST
FOREST CITY NC
28043-3941
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-0786
  • Fax: 828-245-5509
Mailing address:
  • Phone: 828-245-0786
  • Fax: 828-245-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8382
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH9255
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019099
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: