Provider Demographics
NPI:1447655964
Name:BRITTAIN, JEFFERY (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
Last Name:BRITTAIN
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 1:650 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3921
Mailing Address - Country:US
Mailing Address - Phone:850-747-9786
Mailing Address - Fax:850-747-9789
Practice Address - Street 1:650 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3921
Practice Address - Country:US
Practice Address - Phone:850-747-9786
Practice Address - Fax:850-747-9789
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS51542OtherPHARMACIST LICENSE