Provider Demographics
NPI:1710444518
Name:ELLWOOD, BRITTANY JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:JEAN
Last Name:ELLWOOD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:JEAN
Other - Last Name:SHAKESPEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 15313
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5313
Mailing Address - Country:US
Mailing Address - Phone:801-859-1685
Mailing Address - Fax:
Practice Address - Street 1:1240 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3373
Practice Address - Country:US
Practice Address - Phone:805-528-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6102013-1701183500000X
CARPH78407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist