Provider Demographics
NPI:1235613035
Name:BEDI, SAHIBA
Entity Type:Individual
Prefix:
First Name:SAHIBA
Middle Name:
Last Name:BEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-5072
Mailing Address - Country:US
Mailing Address - Phone:801-615-3646
Mailing Address - Fax:
Practice Address - Street 1:5845 E AVE BLDG 412
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5303
Practice Address - Country:US
Practice Address - Phone:801-586-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8071123-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist