NPI Code Detail JSON Logo

1154048338 NPI number — WEDGEWOOD PHARMACY LLC

NPI Number: 1154048338
Health Care Provider/Practitioner: WEDGEWOOD PHARMACY LLC

Information about “1154048338” NPI (WEDGEWOOD PHARMACY LLC) exists in 1154048338 in HTML format HTML  |  1154048338 in plain Text format TXT  |  1154048338 in PDF (Portable Document Format) PDF  |  1154048338 in an XML format XML  formats.

NPI Number : 1154048338 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154048338",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WEDGEWOOD PHARMACY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "405 HERON DRIVE",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "SWEDESBORO",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08085",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-331-8272",
    "MailingAddressFaxNumber": "856-491-4365",
    "FirstLinePracticeLocationAddress": "5301 YOUNG STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAKERSFIELD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93311-8978",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-734-3338",
    "PracticeLocationAddressFaxNumber": "856-491-4365",
    "EnumerationDate": "10/27/2022",
    "LastUpdateDate": "05/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BERNAL-ANGEL",
    "AuthorizedOfficialFirstName": "ALEJANDRO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER, SECRETARY",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "973-307-7154",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336M0002X",
          "TaxonomyName": "Mail Order Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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