Provider Demographics
NPI:1316213952
Name:FENTON, BRIDGET NOREEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:NOREEN
Last Name:FENTON
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 1:1950 ZUMBEHL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2721
Mailing Address - Country:US
Mailing Address - Phone:636-947-0311
Mailing Address - Fax:314-739-1079
Practice Address - Street 1:1950 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:314-291-2290
Practice Address - Fax:314-739-1079
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010028735OtherPHARMACIST LICENSE