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NPI Code Detail

MEDICARE: MR. WILLIAM ROBERT BRIDEWELL

MEDICARE: MR. WILLIAM ROBERT BRIDEWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2187WY
21835G0303XGeriatric Pharmacist2187WY

General Provider Information

NPI Number : 1528376654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM ROBERT BRIDEWELL
Provider Business Mailing Address
First Line : 1105 LOUSIANA CIRCLE
Second Line :
City : GREEN RIVER
State : WY
Zip : 82935-8293
Country : US
Telephone Number : 307-875-4411
Fax Number : 307-382-8084
Provider Business Practice Location Address
First Line : 70 GATEWAY BLVD
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5709
Country : US
Telephone Number : 307-382-2536
Fax Number : 307-382-8084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2010
Last Update Date : 09/23/2010

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