Provider Demographics
NPI:1003060856
Name:HENNEMAN, BRIDGET MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:MARY
Last Name:HENNEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6019
Mailing Address - Country:US
Mailing Address - Phone:480-969-6234
Mailing Address - Fax:480-833-8158
Practice Address - Street 1:554 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6019
Practice Address - Country:US
Practice Address - Phone:480-969-6234
Practice Address - Fax:480-833-8158
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00064950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist