Provider Demographics
NPI:1750022588
Name:BEDRICH, RONNIE (RPH)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:BEDRICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 PEAVY SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7398
Mailing Address - Country:US
Mailing Address - Phone:936-585-2018
Mailing Address - Fax:
Practice Address - Street 1:1807 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5108
Practice Address - Country:US
Practice Address - Phone:936-634-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist