Provider Demographics
NPI:1811243710
Name:BRITTAIN, ALEX
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BRITTAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15080 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-3600
Mailing Address - Country:US
Mailing Address - Phone:704-882-2297
Mailing Address - Fax:
Practice Address - Street 1:15080 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-3600
Practice Address - Country:US
Practice Address - Phone:704-882-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist