Provider Demographics
NPI:1407941834
Name:DOLAN, BRIDGET BRENNAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:BRENNAN
Last Name:DOLAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:BRIDGET
Other - Middle Name:HELEN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1481 W. 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-2828
Mailing Address - Fax:
Practice Address - Street 1:1481 W. 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015694A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist