Provider Demographics
NPI:1487244976
Name:ATHERHOLT, BRITNEE
Entity type:Individual
Prefix:
First Name:BRITNEE
Middle Name:
Last Name:ATHERHOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UNIVERSITY BLVD APT 624
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-8012
Mailing Address - Country:US
Mailing Address - Phone:570-690-2188
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY BLVD APT 624
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8012
Practice Address - Country:US
Practice Address - Phone:570-690-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist