Provider Demographics
NPI:1790077477
Name:BEDARD PHARMACY, INC.
Entity Type:Organization
Organization Name:BEDARD PHARMACY, INC.
Other - Org Name:BEDARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-440-2223
Mailing Address - Street 1:359 MINOT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3303
Mailing Address - Country:US
Mailing Address - Phone:207-783-1410
Mailing Address - Fax:
Practice Address - Street 1:359 MINOT AVE STE B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4329
Practice Address - Country:US
Practice Address - Phone:207-783-1410
Practice Address - Fax:207-333-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130315OtherPK