Provider Demographics
NPI:1730530478
Name:WALLEN, BRITTANY JILL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:JILL
Last Name:WALLEN
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 1:921 DESIRE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-6249
Mailing Address - Country:US
Mailing Address - Phone:865-603-5675
Mailing Address - Fax:
Practice Address - Street 1:500 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4705
Practice Address - Country:US
Practice Address - Phone:504-482-3100
Practice Address - Fax:504-208-3526
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021507183500000X
CTPCT.0012734183500000X
NY060005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist