Provider Demographics
NPI:1023779212
Name:WEDGEWOOD PHARMACY LLC
Entity type:Organization
Organization Name:WEDGEWOOD PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL-ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-307-7154
Mailing Address - Street 1:405 HERON DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:800-331-8272
Mailing Address - Fax:856-491-4365
Practice Address - Street 1:4340 GEORGETOWN ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-9115
Practice Address - Country:US
Practice Address - Phone:859-389-7470
Practice Address - Fax:856-491-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy