Provider Demographics
NPI:1922337328
Name:LAI, BRIDGETTE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:LAI
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 1:2601 LA FRONTERA BLVD
Mailing Address - Street 2:APT 3311
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:512-751-4864
Mailing Address - Fax:
Practice Address - Street 1:2614 S 31ST ST
Practice Address - Street 2:APT 3311
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:512-751-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist