Healthcare Provider Details

I. General information

NPI: 1710343462
Provider Name (Legal Business Name): BRITTANY FAISON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 N FRONTAGE RD W
VAIL CO
81657-4897
US

IV. Provider business mailing address

3570 HARTSEL DR
COLORADO SPRINGS CO
80920-4165
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1621
  • Fax:
Mailing address:
  • Phone: 719-590-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15678
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21234
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: