Provider Demographics
NPI:1275137333
Name:BRIGGEMAN, DAVID EDWARD
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:BRIGGEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 SUNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8338
Mailing Address - Country:US
Mailing Address - Phone:614-313-4798
Mailing Address - Fax:
Practice Address - Street 1:2565 LONDON GROVEPORT RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9035
Practice Address - Country:US
Practice Address - Phone:614-277-2921
Practice Address - Fax:614-277-2926
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist