Healthcare Provider Details

I. General information

NPI: 1669008777
Provider Name (Legal Business Name): BRIENNE L COSTIGAN PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIENNE L DUFRESNE PHARMD

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

206 STEERE ST
ATTLEBORO MA
02703-5228
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-2251
  • Fax:
Mailing address:
  • Phone: 774-451-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPH235206
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: