Provider Demographics
NPI:1487158069
Name:HOLMAN, BRIDGET (RPH)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6888 GOODMAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8759
Mailing Address - Country:US
Mailing Address - Phone:662-349-6385
Mailing Address - Fax:662-932-2099
Practice Address - Street 1:3171 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0405
Practice Address - Country:US
Practice Address - Phone:662-349-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09003183500000X
TN10314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty