1851857759 NPI number — AMY RENAE BRITTIN PHARMD

Table of content: AMY RENAE BRITTIN PHARMD (NPI 1851857759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851857759 NPI number — AMY RENAE BRITTIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITTIN
Provider First Name:
AMY
Provider Middle Name:
RENAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WUOBIO
Provider Other First Name:
AMY
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851857759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2672 E MAPLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48381-3642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-326-0189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41460 HAGGERTY CIR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48188-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-282-5166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5315123312 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 5302041754 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5302041754 . This is a "MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5315123312 . This is a "MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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