Healthcare Provider Details

I. General information

NPI: 1164682068
Provider Name (Legal Business Name): LORAINE T BEDOYA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HENRY ST
COMMACK NY
11725-5423
US

IV. Provider business mailing address

4 HENRY ST
COMMACK NY
11725-5423
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-5463
  • Fax: 631-462-5463
Mailing address:
  • Phone: 631-462-5463
  • Fax: 631-462-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: