Healthcare Provider Details

I. General information

NPI: 1396786109
Provider Name (Legal Business Name): BRIDGETT A EDGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17788 147TH ST SE
MONROE WA
98272-1030
US

IV. Provider business mailing address

412 ANDERSON LN
GOLD BAR WA
98251-9147
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7351
  • Fax: 360-794-5751
Mailing address:
  • Phone: 360-799-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00041168
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: