Provider Demographics
NPI:1164060638
Name:BROWN, JAMIE BLAINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BLAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:BLAINE
Other - Last Name:MYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1345 HWY 4 SPUR SW
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701
Mailing Address - Country:US
Mailing Address - Phone:870-836-3324
Mailing Address - Fax:870-836-3715
Practice Address - Street 1:1345 HWY 4 SPUR SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701
Practice Address - Country:US
Practice Address - Phone:870-836-3324
Practice Address - Fax:870-836-3715
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist