Healthcare Provider Details

I. General information

NPI: 1164026050
Provider Name (Legal Business Name): BEDCOVET PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MADISON ST
SHELBYVILLE TN
37160-3519
US

IV. Provider business mailing address

710 MADISON ST
SHELBYVILLE TN
37160-3519
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-7400
  • Fax: 850-921-5389
Mailing address:
  • Phone: 931-684-7400
  • Fax: 850-921-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAWN GOULDING
Title or Position: VP
Credential:
Phone: 631-459-6514