Provider Demographics
NPI:1144478439
Name:RIDLEY, EMMA J (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:J
Last Name:RIDLEY
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:SUMTER OAKS PARK
Mailing Address - Street 2:4602 COUNY RD. 673, #14107
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513
Mailing Address - Country:US
Mailing Address - Phone:207-944-3826
Mailing Address - Fax:
Practice Address - Street 1:SUMTER OAKS PARK
Practice Address - Street 2:4602 COUNY RD. 673, #14107
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513
Practice Address - Country:US
Practice Address - Phone:207-944-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist