Healthcare Provider Details

I. General information

NPI: 1538164033
Provider Name (Legal Business Name): BEDWICK'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 HAZLE ST
WILKES BARRE PA
18702-4627
US

IV. Provider business mailing address

452 HAZLE ST
WILKES BARRE PA
18702-4627
US

V. Phone/Fax

Practice location:
  • Phone: 570-823-3818
  • Fax: 570-825-6189
Mailing address:
  • Phone: 570-823-3818
  • Fax: 570-825-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412380L
License Number StatePA

VIII. Authorized Official

Name: GEORGE BEDWICK
Title or Position: OWNER PHARMACIST
Credential:
Phone: 570-823-3818