Organization
VIDALIA PHARMACY INC
Active
Other names
VIDALIA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER BEDINGFIELD (OWNER)
(912) 537-4134
Entity
Organization
Contact information
Practice address
209 JACKSON ST, VIDALIA, GA 30474-4713
(912) 537-4134
(912) 537-4169
Mailing address
209 JACKSON ST, VIDALIA, GA 30474-4713
(912) 537-4134
(912) 537-4169
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005032
GA
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037749A
—
GA
01
—
2012881
PK
—
Enumeration date
06/12/2006
Last updated
11/23/2016
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