Provider Demographics
NPI:1194253062
Name:BEDNARZ, AMBER (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WINTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4330
Mailing Address - Country:US
Mailing Address - Phone:860-620-9060
Mailing Address - Fax:
Practice Address - Street 1:505 N. MAIN ST.
Practice Address - Street 2:STOP AND SHOP PHARMACY
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-0648
Practice Address - Country:US
Practice Address - Phone:860-620-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist