Healthcare Provider Details

I. General information

NPI: 1104201847
Provider Name (Legal Business Name): BRIAN WILLIAM BEDWICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HANOVER ST STE 200
WILKES BARRE PA
18702-3544
US

IV. Provider business mailing address

166 HANOVER ST STE 200
WILKES BARRE PA
18702-3544
US

V. Phone/Fax

Practice location:
  • Phone: 570-849-7582
  • Fax: 570-200-7509
Mailing address:
  • Phone: 570-849-7582
  • Fax: 570-200-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449639
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP449639
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: