Provider Demographics
NPI:1699229831
Name:BOLAND, BRITTANY ALYSSA SHANNELLE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:ALYSSA SHANNELLE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8109
Mailing Address - Country:US
Mailing Address - Phone:276-666-5964
Mailing Address - Fax:847-396-2687
Practice Address - Street 1:2876 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8109
Practice Address - Country:US
Practice Address - Phone:276-666-5964
Practice Address - Fax:847-396-2687
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist