Healthcare Provider Details

I. General information

NPI: 1548885437
Provider Name (Legal Business Name): BRIDGETT WINBORN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21800 LIBBY RD
MAPLE HEIGHTS OH
44137-2947
US

IV. Provider business mailing address

1712 BRAINARD RD
LYNDHURST OH
44124-3041
US

V. Phone/Fax

Practice location:
  • Phone: 216-662-7470
  • Fax: 216-662-1166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03129801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: