Provider Demographics
NPI:1346689478
Name:WILSON, BRIDGET ANNETTE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANNETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5053
Mailing Address - Country:US
Mailing Address - Phone:870-850-6084
Mailing Address - Fax:870-850-6361
Practice Address - Street 1:2503 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5053
Practice Address - Country:US
Practice Address - Phone:870-850-6084
Practice Address - Fax:870-850-6361
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist