# VIDALIA PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VIDALIA PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114969342
- **Authorized official:** WALTER BEDINGFIELD (OWNER)
- **Authorized official phone:** (912) 537-4134

## Contact information

- **Practice address:** 209 JACKSON ST, VIDALIA, GA 30474-4713
- **Practice address phone:** (912) 537-4134
- **Practice address fax:** (912) 537-4169
- **Mailing address:** 209 JACKSON ST, VIDALIA, GA 30474-4713
- **Mailing address phone:** (912) 537-4134
- **Mailing address fax:** (912) 537-4169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 005032 | GA | Yes |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 11/23/2016