Provider Demographics
NPI:1447625538
Name:IAQUINTA, BRITTNI
Entity type:Individual
Prefix:
First Name:BRITTNI
Middle Name:
Last Name:IAQUINTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 RICHWOOD HALL RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-2804
Mailing Address - Country:US
Mailing Address - Phone:304-677-3525
Mailing Address - Fax:
Practice Address - Street 1:191 MARKET ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4750
Practice Address - Country:US
Practice Address - Phone:540-545-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist