Provider Demographics
NPI:1245421742
Name:BRIDGE, RYAN RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5711
Mailing Address - Country:US
Mailing Address - Phone:352-256-3629
Mailing Address - Fax:
Practice Address - Street 1:5180 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5346
Practice Address - Country:US
Practice Address - Phone:407-589-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS424241835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric