Provider Demographics
NPI:1033460944
Name:BRIDGERS, MARVIN WARREN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:WARREN
Last Name:BRIDGERS
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-822-4383
Mailing Address - Fax:804-965-0987
Practice Address - Street 1:5000 COX RD
Practice Address - Street 2:STE 100
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9263
Practice Address - Country:US
Practice Address - Phone:804-822-4383
Practice Address - Fax:804-965-0987
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist