Provider Demographics
NPI:1750820023
Name:BA, BRIANNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:BA
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 1:441 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4149
Mailing Address - Country:US
Mailing Address - Phone:860-405-1919
Mailing Address - Fax:860-405-1926
Practice Address - Street 1:441 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4149
Practice Address - Country:US
Practice Address - Phone:860-405-1919
Practice Address - Fax:860-405-1926
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012457183500000X
MEPR5467183500000X
COPHA.0017221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist