Provider Demographics
NPI:1285001602
Name:HENDERSON-SUTTON, BRITTANY LEA
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEA
Last Name:HENDERSON-SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1206
Mailing Address - Country:US
Mailing Address - Phone:469-383-4149
Mailing Address - Fax:
Practice Address - Street 1:1306 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1206
Practice Address - Country:US
Practice Address - Phone:214-483-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist