Provider Demographics
NPI:1962833913
Name:VESTAL, BRIDGETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:VESTAL
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 1:935 STATE HWY 11 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874
Mailing Address - Country:US
Mailing Address - Phone:423-337-3052
Mailing Address - Fax:
Practice Address - Street 1:935 STATE HWY 11 SOUTH
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874
Practice Address - Country:US
Practice Address - Phone:423-337-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist