Provider Demographics
NPI:1184942740
Name:BRIDGES, MELISSA K (PHARM D)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:BRIDGES
Suffix:
Gender:F
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 1:1900 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6153
Mailing Address - Country:US
Mailing Address - Phone:920-233-4287
Mailing Address - Fax:920-252-8327
Practice Address - Street 1:1900 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6153
Practice Address - Country:US
Practice Address - Phone:920-233-4287
Practice Address - Fax:920-252-8327
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292649183500000X
WI16239-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist