Provider Demographics
NPI:1134647423
Name:BDRX 2 LLC
Entity Type:Organization
Organization Name:BDRX 2 LLC
Other - Org Name:SMALL TOWN PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-905-7610
Mailing Address - Street 1:80 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1565
Mailing Address - Country:US
Mailing Address - Phone:610-279-6575
Mailing Address - Fax:610-279-2430
Practice Address - Street 1:80 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1565
Practice Address - Country:US
Practice Address - Phone:610-279-6575
Practice Address - Fax:610-279-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
PAPP4827663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034224450001Medicaid
2171480OtherPK