Basic Information
| Provider Information | |||||||||
| NPI: | 1003149857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLONE | ||||||||
| FirstName: | BRIDGETTE | ||||||||
| MiddleName: | THACKER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 COLLINS CIR | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416537913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068863884 | ||||||||
| FaxNumber: | 6068863855 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 COLLINS CIR | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416537913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068863884 | ||||||||
| FaxNumber: | 6068863855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 014586 | KY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.