Healthcare Provider Details
I. General information
NPI: 1447535042
Provider Name (Legal Business Name): DR. MICHAEL S KIRKBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/14/2011
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1175 MARINERS WAY UNIT 111
HUDDLESTON VA
24104-3634
US
IV. Provider business mailing address
PO BOX 227
HUDDLESTON VA
24104-0227
US
V. Phone/Fax
- Phone: 540-529-0635
- Fax:
- Phone: 540-529-0635
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 0202012614 |
| License Number State | VA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | RP033600L |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 28RI01860400 |
| License Number State | NJ |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 19110 |
| License Number State | MD |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 33421 |
| License Number State | TN |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | PD12235 |
| License Number State | AR |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | PS45337 |
| License Number State | FL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 014367 |
| License Number State | KY |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | S018429 |
| License Number State | AZ |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 13732 |
| License Number State | NE |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | PST 019683 |
| License Number State | LA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | T-12088 |
| License Number State | MS |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | 18185 |
| License Number State | NV |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
