Provider Demographics
NPI:1053658245
Name:BROWN, CHARLES LEE (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17445 US HIGHWAY 192
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7016
Mailing Address - Country:US
Mailing Address - Phone:352-243-0785
Mailing Address - Fax:352-243-0785
Practice Address - Street 1:17445 US HIGHWAY 192
Practice Address - Street 2:SUITE 11
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7016
Practice Address - Country:US
Practice Address - Phone:352-243-0785
Practice Address - Fax:352-243-0785
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist