Provider Demographics
NPI:1447292909
Name:BEDFORD PHARMACY LLC
Entity type:Organization
Organization Name:BEDFORD PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM D / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGHDAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, PHARMD
Authorized Official - Phone:718-933-1154
Mailing Address - Street 1:387 BEDFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2422
Mailing Address - Country:US
Mailing Address - Phone:718-933-1154
Mailing Address - Fax:718-365-0202
Practice Address - Street 1:387 BEDFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2422
Practice Address - Country:US
Practice Address - Phone:718-933-1154
Practice Address - Fax:718-365-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0269413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594829Medicaid
2060384OtherPK
3366540OtherNCPDP PROVIDER IDENTIFICATION NUMBER