Provider Demographics
NPI:1487236741
Name:BOLDEN, BRITTANY LEE (CPHT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E WALTON ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9159
Mailing Address - Country:US
Mailing Address - Phone:419-935-3900
Mailing Address - Fax:
Practice Address - Street 1:4 E WALTON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9159
Practice Address - Country:US
Practice Address - Phone:419-935-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09308923183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician