Provider Demographics
NPI:1093451924
Name:BEDOYA, KENNY (RPH)
Entity type:Individual
Prefix:DR
First Name:KENNY
Middle Name:
Last Name:BEDOYA
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 1:46 W HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1719
Mailing Address - Country:US
Mailing Address - Phone:201-556-7581
Mailing Address - Fax:
Practice Address - Street 1:20 W HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1788
Practice Address - Country:US
Practice Address - Phone:201-408-1374
Practice Address - Fax:201-408-1381
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04239300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist