Healthcare Provider Details

I. General information

NPI: 1770503260
Provider Name (Legal Business Name): BECHTEL'S PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 LEHIGH DR
WALNUTPORT PA
18088-9513
US

IV. Provider business mailing address

4423 LEHIGH DR
WALNUTPORT PA
18088-9513
US

V. Phone/Fax

Practice location:
  • Phone: 610-767-9020
  • Fax: 610-760-9449
Mailing address:
  • Phone: 610-767-9020
  • Fax: 610-760-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP413870L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPP413870L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413870L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3952733
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCPDP
# 2
Identifier1007638610001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: EDWARD JOSEPH BECHTEL
Title or Position: PRESIDENT
Credential: RPH
Phone: 610-767-9020