Healthcare Provider Details

I. General information

NPI: 1801498407
Provider Name (Legal Business Name): BRIDGETTE ZICKEFOOSE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 W ALEX BELL RD
DAYTON OH
45459-1127
US

IV. Provider business mailing address

8235 HYANNIS PORT DR APT 3A
DAYTON OH
45458-1722
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-7210
  • Fax:
Mailing address:
  • Phone: 330-814-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03439763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: