Provider Demographics
NPI:1245599182
Name:FLAVIN, BRIDGET M (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:FLAVIN
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 1:2103 W BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3519
Mailing Address - Country:US
Mailing Address - Phone:503-295-6480
Mailing Address - Fax:
Practice Address - Street 1:2103 W BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3519
Practice Address - Country:US
Practice Address - Phone:503-295-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012919183500000X
MO2011026572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist