MEDICARE: MR. JEFFREY J BEDNARCIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835G0303X	Geriatric Pharmacist	03316777	OH
2	183500000X	Pharmacist	03316777	OH

General Provider Information

NPI Number	:	1538763461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY J BEDNARCIK

Provider Business Mailing Address
First Line	:	35550 HANNA RD
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-8422
Country	:	US
Telephone Number	:	440-376-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 MAYFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4016
Country	:	US
Telephone Number	:	216-691-8988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	11/22/2020

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