Provider Demographics
NPI:1932482510
Name:REAGAN, BRIDGET L (RPH)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:L
Last Name:REAGAN
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 1:14700 LAC LAVON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6398
Mailing Address - Country:US
Mailing Address - Phone:952-432-5557
Mailing Address - Fax:952-432-1271
Practice Address - Street 1:14700 LAC LAVON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6398
Practice Address - Country:US
Practice Address - Phone:952-432-5557
Practice Address - Fax:952-432-1271
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113283183500000X
ND3929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist