Provider Demographics
NPI:1669008777
Name:COSTIGAN, BRIENNE L (PHARMD, BCPPS)
Entity Type:Individual
Prefix:DR
First Name:BRIENNE
Middle Name:L
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:PHARMD, BCPPS
Other - Prefix:DR
Other - First Name:BRIENNE
Other - Middle Name:L
Other - Last Name:DUFRESNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:206 STEERE ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5228
Mailing Address - Country:US
Mailing Address - Phone:774-451-7214
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2352061835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics