Provider Demographics
NPI:1104201847
Name:BEDWICK, BRIAN WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:BEDWICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HANOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3544
Mailing Address - Country:US
Mailing Address - Phone:570-849-7582
Mailing Address - Fax:570-200-7509
Practice Address - Street 1:166 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3544
Practice Address - Country:US
Practice Address - Phone:570-849-7582
Practice Address - Fax:570-200-7509
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449639183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist