Provider Demographics
NPI:1225719644
Name:BROWN, NATHALIE ANN
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:ANN
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 1:137 MCESTHER DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18424-7896
Mailing Address - Country:US
Mailing Address - Phone:570-954-2192
Mailing Address - Fax:
Practice Address - Street 1:1619 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5910
Practice Address - Country:US
Practice Address - Phone:203-259-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist