Provider Demographics
NPI:1346281342
Name:BEDFORD ROAD PHARMACY, INC.
Entity Type:Organization
Organization Name:BEDFORD ROAD PHARMACY, INC.
Other - Org Name:PHARMACARE OF CUMBERLAND - HME/DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-723-2444
Mailing Address - Street 1:11306 BEDFORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6802
Mailing Address - Country:US
Mailing Address - Phone:301-723-2444
Mailing Address - Fax:301-777-0119
Practice Address - Street 1:11306 BEDFORD RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6802
Practice Address - Country:US
Practice Address - Phone:301-723-2444
Practice Address - Fax:301-777-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP00033332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420138800Medicaid
MD420138800Medicaid