Provider Demographics
NPI:1801498407
Name:ZICKEFOOSE, BRIDGETTE (RPH)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:ZICKEFOOSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 HYANNIS PORT DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1722
Mailing Address - Country:US
Mailing Address - Phone:330-814-2934
Mailing Address - Fax:
Practice Address - Street 1:2917 W ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1127
Practice Address - Country:US
Practice Address - Phone:937-294-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034397631835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist