Provider Demographics
NPI:1437873569
Name:BRIDGES, JONATHAN CUENTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CUENTIN
Last Name:BRIDGES
Suffix:
Gender:M
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:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-0527
Mailing Address - Country:US
Mailing Address - Phone:843-623-2999
Mailing Address - Fax:843-623-3615
Practice Address - Street 1:700 CHESTERFIELD HWY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7001
Practice Address - Country:US
Practice Address - Phone:843-537-3221
Practice Address - Fax:843-537-9550
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist