Provider Demographics
NPI:1083298921
Name:THIBODEAU, BRITNI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRITNI
Middle Name:
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S BLUE ANGEL PKWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6905
Mailing Address - Country:US
Mailing Address - Phone:850-454-3001
Mailing Address - Fax:
Practice Address - Street 1:2950 S BLUE ANGEL PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6905
Practice Address - Country:US
Practice Address - Phone:850-454-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist