Provider Demographics
NPI:1376131771
Name:TENIOLA, BRIDGETTE OLUTOSIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:OLUTOSIN
Last Name:TENIOLA
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 1:8400 BASS LAKE RD APT 352
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5348
Mailing Address - Country:US
Mailing Address - Phone:954-980-2733
Mailing Address - Fax:
Practice Address - Street 1:15800 87TH ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6546
Practice Address - Country:US
Practice Address - Phone:763-252-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist