Provider Demographics
NPI:1518210251
Name:WHITLOW, BRIANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:STAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1370 13TH AVE S STE 117
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3206
Mailing Address - Country:US
Mailing Address - Phone:904-241-0116
Mailing Address - Fax:
Practice Address - Street 1:1370 13TH AVE S STE 117
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-3206
Practice Address - Country:US
Practice Address - Phone:904-241-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist