Provider Demographics
NPI:1164026050
Name:BEDCOVET PHARMACY
Entity Type:Organization
Organization Name:BEDCOVET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-459-6514
Mailing Address - Street 1:710 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3519
Mailing Address - Country:US
Mailing Address - Phone:931-684-7400
Mailing Address - Fax:850-921-5389
Practice Address - Street 1:710 MADISON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3519
Practice Address - Country:US
Practice Address - Phone:931-684-7400
Practice Address - Fax:850-921-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy