Provider Demographics
NPI:1700375102
Name:BRIGGS, ALYSE N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:N
Last Name:BRIGGS
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 1:3805 S KANSAS EXPY STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6989
Mailing Address - Country:US
Mailing Address - Phone:417-269-0269
Mailing Address - Fax:
Practice Address - Street 1:3805 S KANSAS EXPY STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6989
Practice Address - Country:US
Practice Address - Phone:417-269-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027731A183500000X
MO20200253111835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020025311OtherPHARMACIST - MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
IN26027731AOtherPHARMACIST - INDIANA PROFESSIONAL LICENSING AGENCY