Provider Demographics
NPI:1336468339
Name:BRITTLE, GEORGE D
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:D
Last Name:BRITTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3020
Mailing Address - Country:US
Mailing Address - Phone:757-422-0330
Mailing Address - Fax:757-417-6515
Practice Address - Street 1:320 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3020
Practice Address - Country:US
Practice Address - Phone:757-422-0330
Practice Address - Fax:757-417-6515
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist