Provider Demographics
NPI:1447535042
Name:KIRKBRIDE, MICHAEL S
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:KIRKBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:HUDDLESTON
Mailing Address - State:VA
Mailing Address - Zip Code:24104-0227
Mailing Address - Country:US
Mailing Address - Phone:540-529-0635
Mailing Address - Fax:
Practice Address - Street 1:1175 MARINERS WAY
Practice Address - Street 2:UNIT 111
Practice Address - City:HUDDLESTON
Practice Address - State:VA
Practice Address - Zip Code:24104-3634
Practice Address - Country:US
Practice Address - Phone:540-529-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020126141835G0303X
PARP033600L1835G0303X
NJ28RI018604001835G0303X
MD191101835G0303X
TN334211835G0303X
ARPD122351835G0303X
FLPS453371835G0303X
KY0143671835G0303X
AZS0184291835G0303X
NE137321835G0303X
LAPST 0196831835G0303X
MST-120881835G0303X
NV181851835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric