Healthcare Provider Details

I. General information

NPI: 1285156422
Provider Name (Legal Business Name): WILLIAM BEDWICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E BROWN ST
EAST STROUDSBURG PA
18301-3006
US

IV. Provider business mailing address

137 CANNERY DR
LARKSVILLE PA
18704-1461
US

V. Phone/Fax

Practice location:
  • Phone: 570-369-7032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030400L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: