Healthcare Provider Details

I. General information

NPI: 1124978366
Provider Name (Legal Business Name): AMANDA BRIDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S RANGE AVE
DENHAM SPRINGS LA
70726-4413
US

IV. Provider business mailing address

8938 MEADOW SAGE DR
DENHAM SPRINGS LA
70726-7060
US

V. Phone/Fax

Practice location:
  • Phone: 225-664-9452
  • Fax:
Mailing address:
  • Phone: 985-705-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023099
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: