Provider Demographics
NPI:1841572583
Name:BARTON, BRIANNA C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:C
Last Name:BARTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:C
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 KINLOCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4450
Mailing Address - Country:US
Mailing Address - Phone:309-251-8705
Mailing Address - Fax:
Practice Address - Street 1:1190 COLLINSVILLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1880
Practice Address - Country:US
Practice Address - Phone:618-343-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295062183500000X
MO2011023407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist