Healthcare Provider Details

I. General information

NPI: 1891185484
Provider Name (Legal Business Name): BRITTANY DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TOWNE CENTER DR
LOUISVILLE KY
40241-4146
US

IV. Provider business mailing address

4101 TOWNE CENTER DR
LOUISVILLE KY
40241-4146
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-2440
  • Fax: 502-653-6943
Mailing address:
  • Phone: 502-412-2440
  • Fax: 502-653-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00023367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: