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General NPI Number Information
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NPI Number | 1508493743
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Entity Type | Individual
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Provider Name | BRENT ERIC BRIDGES PHARM D
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 612 N MAIN ST
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City | HENDERSON
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State | KY
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Zip | 42420-2914
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Country | US
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Telephone | 270-844-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 612 N MAIN ST
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City | HENDERSON
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State | KY
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Zip | 42420-2914
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Country | US
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Telephone | 270-844-2356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26028612A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 011000
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License Number State | KY
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