Provider Demographics
NPI:1033747001
Name:BROWN, GARY ALEXANDER
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALEXANDER
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2116
Mailing Address - Country:US
Mailing Address - Phone:402-245-2029
Mailing Address - Fax:402-245-2521
Practice Address - Street 1:120 E 18TH ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2116
Practice Address - Country:US
Practice Address - Phone:402-245-2029
Practice Address - Fax:402-245-2521
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist