Provider Demographics
NPI:1235757881
Name:CENTRAL BEDFORD PHARMACY, LLC
Entity Type:Organization
Organization Name:CENTRAL BEDFORD PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:PHIT
Authorized Official - Middle Name:THI TRAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:682-738-3099
Mailing Address - Street 1:2117 CENTRAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5883
Mailing Address - Country:US
Mailing Address - Phone:682-738-3099
Mailing Address - Fax:
Practice Address - Street 1:2117 CENTRAL DR STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5883
Practice Address - Country:US
Practice Address - Phone:682-738-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy