Healthcare Provider Details

I. General information

NPI: 1588899850
Provider Name (Legal Business Name): BED WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 W BEECH ST
LONG BEACH NY
11561
US

IV. Provider business mailing address

1054 W BEECH ST
LONG BEACH NY
11561
US

V. Phone/Fax

Practice location:
  • Phone: 516-431-4455
  • Fax: 516-431-4199
Mailing address:
  • Phone: 516-431-4455
  • Fax: 516-431-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOAN WAX
Title or Position: MANAGER
Credential:
Phone: 516-431-4455