MEDICARE: BEDFORD ROAD PHARMACY, INC.

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	3336C0003X	Community/Retail Pharmacy	P00239	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2125854	OTHER	MD	NABP NUMBER

General Provider Information

NPI Number	:	1811938954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD ROAD PHARMACY, INC.

Provider Business Mailing Address
First Line	:	64 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-724-1183
Fax Number	:	301-724-5212

Provider Business Practice Location Address
First Line	:	64 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-724-1183
Fax Number	:	301-724-5212

Authorized Official
Title or Position	:	RETAIL PHARMACY MANAGER
Name	:	MR. KEITH BROOME
Credential	:	RPH
Telephone Number	:	301-724-1183

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	08/22/2020

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