Provider Demographics
NPI:1912251208
Name:BIDWELL, WILLIAM V (R PH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:V
Last Name:BIDWELL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 HIGHLAND RD
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2275
Mailing Address - Country:US
Mailing Address - Phone:330-405-7040
Mailing Address - Fax:
Practice Address - Street 1:1750 HIGHLAND RD
Practice Address - Street 2:SUITE 7B
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2275
Practice Address - Country:US
Practice Address - Phone:330-405-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03214011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03214011OtherOHIO STATE BOARD OF PHARMACY