Provider Demographics
NPI:1801912142
Name:BRITTENHAM, COLEEN (RP, PHARMD)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:BRITTENHAM
Suffix:
Gender:F
Credentials:RP, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BUENA VISTA PT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2028
Mailing Address - Country:US
Mailing Address - Phone:402-721-4142
Mailing Address - Fax:
Practice Address - Street 1:1900 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5433
Practice Address - Country:US
Practice Address - Phone:402-721-1177
Practice Address - Fax:402-721-2288
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist