Healthcare Provider Details

I. General information

NPI: 1528151958
Provider Name (Legal Business Name): BEDFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12130 E LYNCHBURG SALEM TPKE
FOREST VA
24551-3421
US

IV. Provider business mailing address

12130 E LYNCHBURG SALEM TPKE
FOREST VA
24551-3421
US

V. Phone/Fax

Practice location:
  • Phone: 434-525-9444
  • Fax: 434-525-9445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003776
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PRILLMAN
Title or Position: PRES
Credential:
Phone: 434-525-9444