Provider Demographics
NPI:1609470848
Name:BEDIAKO, DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BEDIAKO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LEEWARD DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-5347
Mailing Address - Country:US
Mailing Address - Phone:214-532-4167
Mailing Address - Fax:
Practice Address - Street 1:3706 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1406
Practice Address - Country:US
Practice Address - Phone:214-532-4167
Practice Address - Fax:214-988-3032
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570671835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX57067OtherPRIVATE, VA AND LONG TERM CARE
TX57067OtherPRIVATE, VA AND LONG TERM CARE