Provider Demographics
NPI:1184341315
Name:BRIDGFORD, TAHNEE
Entity type:Individual
Prefix:
First Name:TAHNEE
Middle Name:
Last Name:BRIDGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 41ST DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5434
Mailing Address - Country:US
Mailing Address - Phone:425-501-1794
Mailing Address - Fax:
Practice Address - Street 1:16824 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3167
Practice Address - Country:US
Practice Address - Phone:425-741-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61319350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist