Provider Demographics
NPI:1851857759
Name:BRITTIN, AMY RENAE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENAE
Last Name:BRITTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENAE
Other - Last Name:WUOBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2672 E MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3642
Mailing Address - Country:US
Mailing Address - Phone:989-326-0189
Mailing Address - Fax:
Practice Address - Street 1:41460 HAGGERTY CIR S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2227
Practice Address - Country:US
Practice Address - Phone:888-282-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315123312183500000X
MI5302041754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302041754OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI5315123312OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS