Provider Demographics
NPI:1891458865
Name:KIRKBRIDE, JEREMY DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:KIRKBRIDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 ETY SHOPS WAY NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7768
Mailing Address - Country:US
Mailing Address - Phone:740-654-5219
Mailing Address - Fax:740-654-5502
Practice Address - Street 1:1394 ETY SHOPS WAY NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-7768
Practice Address - Country:US
Practice Address - Phone:740-654-5219
Practice Address - Fax:740-654-5502
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist