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General NPI Number Information
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NPI Number | 1447209978
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Entity Type | Organization
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Legal Business Name | BRIDGE STREET PHARMACY INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 817 N BRIDGE ST
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City | ELKIN
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State | NC
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Zip | 28621
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Country | US
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Telephone | 336-835-3131
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Fax | 336-835-2358
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Provider Business Mailing Address
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Address Line | 817 N BRIDGE ST
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City | ELKIN
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State | NC
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Zip | 28621
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Country | US
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Telephone | 336-835-3131
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Fax | 336-835-2358
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. RICHARD GILL RIPLEY
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Credential | RPH
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Telephone | 336-835-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 07272
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7272
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License Number State | NC
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