1649371139 NPI number — MR. YERVANT Y BEDIKIAN REGISTERD PHARMACIST

Table of content: MR. YERVANT Y BEDIKIAN REGISTERD PHARMACIST (NPI 1649371139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649371139 NPI number — MR. YERVANT Y BEDIKIAN REGISTERD PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEDIKIAN
Provider First Name:
YERVANT
Provider Middle Name:
Y
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERD PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649371139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20755 KENNOWAY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-3849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-645-1490
Provider Business Mailing Address Fax Number:
248-645-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10507 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER ROUGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48218-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-842-2080
Provider Business Practice Location Address Fax Number:
313-842-7901
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302021584 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5302021584 . This is a "RGISTERD PHARMACIST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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