Provider Demographics
NPI:1750042925
Name:CONNALLY, BRITNEY YVONNE
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:YVONNE
Last Name:CONNALLY
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 1:949 WILLIAM D FITCH PKWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4638
Mailing Address - Country:US
Mailing Address - Phone:979-690-4690
Mailing Address - Fax:
Practice Address - Street 1:11675 FM 2154 RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4737
Practice Address - Country:US
Practice Address - Phone:979-485-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28951183700000X
TX72701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician