Provider Demographics
NPI:1578842852
Name:DEVILLE, BRIGETTE
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:
Last Name:DEVILLE
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 1:13131 MONTFORT DR
Mailing Address - Street 2:T-0013
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5112
Mailing Address - Country:US
Mailing Address - Phone:972-239-8161
Mailing Address - Fax:972-239-8161
Practice Address - Street 1:13131 MONTFORT DR
Practice Address - Street 2:T-0013
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5112
Practice Address - Country:US
Practice Address - Phone:972-239-8161
Practice Address - Fax:972-239-8161
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist