Provider Demographics
NPI:1386785236
Name:MOORE, BRIDGET ANTOINETTE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANTOINETTE
Last Name:MOORE
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 1:106 GLEN ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9133
Mailing Address - Country:US
Mailing Address - Phone:404-718-0752
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700700A
Practice Address - Street 2:78 MDG/SGSD
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020240183500000X
LA018719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist