Provider Demographics
NPI:1235352063
Name:BROWN, DONALD JOE (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOE
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 1:1460 BRAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1165
Mailing Address - Country:US
Mailing Address - Phone:573-238-4177
Mailing Address - Fax:573-238-4986
Practice Address - Street 1:106 N FIRST ST
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-0739
Practice Address - Country:US
Practice Address - Phone:573-238-4177
Practice Address - Fax:573-238-4986
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist