Provider Demographics
NPI:1093035974
Name:BROWN, ELOIS
Entity Type:Individual
Prefix:
First Name:ELOIS
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 NATOMA DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6914
Mailing Address - Country:US
Mailing Address - Phone:757-416-1048
Mailing Address - Fax:
Practice Address - Street 1:2330 AZALEA GARDEN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-3974
Practice Address - Country:US
Practice Address - Phone:757-853-7607
Practice Address - Fax:757-858-5320
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist