Provider Demographics
NPI:1508493743
Name:BRIDGES, BRENT ERIC (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ERIC
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 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2914
Mailing Address - Country:US
Mailing Address - Phone:270-844-2356
Mailing Address - Fax:
Practice Address - Street 1:612 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2914
Practice Address - Country:US
Practice Address - Phone:270-844-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028612A183500000X
KY011000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist