Provider Demographics
NPI:1093095259
Name:BROWN, JEREMY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2198
Mailing Address - Country:US
Mailing Address - Phone:541-269-8489
Mailing Address - Fax:
Practice Address - Street 1:1775 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2198
Practice Address - Country:US
Practice Address - Phone:541-269-8489
Practice Address - Fax:912-265-0956
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025976183500000X
ORRPH-0016701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH025976OtherGEORGIA STATE PHARMACY LICENSE
ORRPH-0016701OtherOREGON BOARD OF PHARMACY