Vidalia Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

005032 Issued in GA

Legal business name

VIDALIA PHARMACY INC

Practice address

209 Jackson St
Vidalia, GA 30474-4713

Phone

(912) 537-4134

Fax

(912) 537-4169

NPI assigned

Jun 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Walter Bedingfield

Title

Owner

Phone

(912) 537-4134

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• VIDALIA PHARMACY INC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1114969342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 JACKSON ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304744713",
            "telephone_number": "912-537-4134",
            "fax_number": "912-537-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 JACKSON ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304744713",
            "telephone_number": "912-537-4134",
            "fax_number": "912-537-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALIA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "BEDINGFIELD",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-537-4134"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "005032",
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012881",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0037749A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIDALIA PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vidalia Neurology Associates, LLC
• Vidalia OB GYN
• Vidalia Open MRI, LLC
• Vidalia Oral and Maxillofacial Surgery, P.C.
• Vidalia Orthopedic Center, LLC
• Vidalia Pulmonology Center, LLC
• Vidalia Radiology Associates
• Vidalia Regional Cancer Center
• Vidalia Surgical Associates, LLC
• Vidalia Urology Associates, LLC

• Community/Retail Pharmacy in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.