Provider Demographics
NPI:1114232808
Name:BROWN, JEROME D (RPH)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:D
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 1:1848 RICHLANDTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-9618
Mailing Address - Country:US
Mailing Address - Phone:610-346-9555
Mailing Address - Fax:215-679-0766
Practice Address - Street 1:350 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1316
Practice Address - Country:US
Practice Address - Phone:215-679-4411
Practice Address - Fax:215-679-0766
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035873T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist