Provider Demographics
NPI:1396786109
Name:EDGAR, BRIDGETT A
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:A
Last Name:EDGAR
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 1:412 ANDERSON LN
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-9147
Mailing Address - Country:US
Mailing Address - Phone:360-799-0701
Mailing Address - Fax:
Practice Address - Street 1:17788 147TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1030
Practice Address - Country:US
Practice Address - Phone:360-794-7351
Practice Address - Fax:360-794-5751
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00041168183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician