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General NPI Number Information
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NPI Number | 1124186952
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Entity Type | Organization
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Legal Business Name | WEDGEWOOD PHARMACY LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 7631 E INDIAN SCHOOL ROAD SUITE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85251
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Country | US
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Telephone | 800-331-8272
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Fax | 856-491-4365
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Provider Business Mailing Address
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Address Line | 405 HERON DRIVE SUITE 200
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City | SWEDESBORO
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State | NJ
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Zip | 08085
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Country | US
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Telephone | 800-331-8272
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Fax | 856-491-4365
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER, SECRETARY
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Name | ALEJANDRO BERNAL-ANGEL
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Credential |
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Telephone | 973-307-7154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | NP000022
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | Y006134
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License Number State | AZ
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