Provider Demographics
NPI:1568007995
Name:BRITTENHAM, KAYSIE
Entity Type:Individual
Prefix:
First Name:KAYSIE
Middle Name:
Last Name:BRITTENHAM
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 1:2109 HUGHES DR STE 550
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5103
Mailing Address - Country:US
Mailing Address - Phone:419-291-2010
Mailing Address - Fax:419-480-8715
Practice Address - Street 1:2109 HUGHES DR STE 550
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5103
Practice Address - Country:US
Practice Address - Phone:419-291-2010
Practice Address - Fax:419-480-8715
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist