Provider Demographics
NPI:1134503048
Name:BROWN, WADE HARRELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:HARRELL
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 1:5179 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-9516
Mailing Address - Country:US
Mailing Address - Phone:910-483-9482
Mailing Address - Fax:910-483-9480
Practice Address - Street 1:5179 CLINTON RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-9516
Practice Address - Country:US
Practice Address - Phone:910-483-9482
Practice Address - Fax:910-483-9480
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist