Healthcare Provider Details

I. General information

NPI: 1982600128
Provider Name (Legal Business Name): BEDFORD PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ROUTE 101 101 PLAZA
BEDFORD NH
03110-5440
US

IV. Provider business mailing address

209 ROUTE 101 101 PLAZA
BEDFORD NH
03110-5440
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-3919
  • Fax: 603-472-7448
Mailing address:
  • Phone: 603-472-3919
  • Fax: 603-472-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51
License Number StateNH

VIII. Authorized Official

Name: RONALD PETRIN
Title or Position: PRESIDENT
Credential: RPH
Phone: 603-472-3939