Healthcare Provider Details

I. General information

NPI: 1427194570
Provider Name (Legal Business Name): BRIDGE STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N BRIDGE ST
ELKIN NC
28621-3008
US

IV. Provider business mailing address

817 N BRIDGE ST
ELKIN NC
28621-3008
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-3131
  • Fax: 336-835-2358
Mailing address:
  • Phone: 336-835-3131
  • Fax: 336-835-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07272
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07272
License Number StateNC

VIII. Authorized Official

Name: MR. RICHARD GILL RIPLEY
Title or Position: PRESIDENT/OWNER/MANAGER
Credential: PHARMACIST
Phone: 336-835-3131