Provider Demographics
NPI:1568403582
Name:BEDFORD ROAD PHARMACY
Entity Type:Organization
Organization Name:BEDFORD ROAD PHARMACY
Other - Org Name:PHARMACARE INSTITUTIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-777-1773
Mailing Address - Street 1:3 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1092
Mailing Address - Country:US
Mailing Address - Phone:301-777-1773
Mailing Address - Fax:301-777-7109
Practice Address - Street 1:3 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1092
Practice Address - Country:US
Practice Address - Phone:301-777-1773
Practice Address - Fax:301-777-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW01093336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0269480001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER