Provider Demographics
NPI:1003930934
Name:LAKE-BROWN, VIOLETTE (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:VIOLETTE
Middle Name:
Last Name:LAKE-BROWN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5794 BLUEHILL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2016
Mailing Address - Country:US
Mailing Address - Phone:313-882-2304
Mailing Address - Fax:313-394-0228
Practice Address - Street 1:3456 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4200
Practice Address - Country:US
Practice Address - Phone:313-259-6520
Practice Address - Fax:313-394-0228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist