Provider Demographics
NPI:1053911966
Name:TRAVIS, BRITTANY MARY (PHARMD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARY
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CENTER ST # 117
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3926
Mailing Address - Country:US
Mailing Address - Phone:860-288-2119
Mailing Address - Fax:
Practice Address - Street 1:444 CENTER ST # 117
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3926
Practice Address - Country:US
Practice Address - Phone:860-288-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist