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General NPI Number Information
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NPI Number | 1851857270
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Entity Type | Organization
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Legal Business Name | BRIDGE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 1955 MCCULLOCH BLVD N # 100
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5739
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Country | US
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Telephone | 928-230-9812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1257
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-1257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EZEKIEL KEERENG KESITILWE
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Credential | PHARMD
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Telephone | 928-230-9812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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