Provider Demographics
NPI:1982812251
Name:BRIDGES, KENT (RPH)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROWELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1313
Mailing Address - Country:US
Mailing Address - Phone:207-299-6557
Mailing Address - Fax:
Practice Address - Street 1:61 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6805
Practice Address - Country:US
Practice Address - Phone:207-778-6013
Practice Address - Fax:207-786-0763
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09163183500000X
MEPR4868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist