Provider Demographics
NPI:1982600128
Name:BEDFORD PHARMACY CORP.
Entity Type:Organization
Organization Name:BEDFORD PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-472-3939
Mailing Address - Street 1:209 ROUTE 101
Mailing Address - Street 2:101 PLAZA
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5440
Mailing Address - Country:US
Mailing Address - Phone:603-472-3919
Mailing Address - Fax:603-472-7448
Practice Address - Street 1:209 ROUTE 101
Practice Address - Street 2:101 PLAZA
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5440
Practice Address - Country:US
Practice Address - Phone:603-472-3919
Practice Address - Fax:603-472-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3003023Medicaid
NH3003023Medicare ID - Type Unspecified