Provider Demographics
NPI:1265033419
Name:BRIGTSEN, EMILY MAXEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAXEY
Last Name:BRIGTSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7268
Mailing Address - Country:US
Mailing Address - Phone:662-801-3377
Mailing Address - Fax:
Practice Address - Street 1:205 HOUSE CARLSON DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-7643
Practice Address - Country:US
Practice Address - Phone:662-563-1384
Practice Address - Fax:662-563-6559
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE09680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist