Provider Demographics
NPI:1528059359
Name:BRIDGES, ROBERT REGINALD (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:REGINALD
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 1:8106 MOUNTAIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5910
Mailing Address - Country:US
Mailing Address - Phone:801-942-5049
Mailing Address - Fax:
Practice Address - Street 1:3730 W 4700 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-3457
Practice Address - Country:US
Practice Address - Phone:801-213-9236
Practice Address - Fax:801-213-9202
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150420-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist