Provider Demographics
NPI:1265643159
Name:BROWN, ORVILLE DONALD III
Entity Type:Individual
Prefix:
First Name:ORVILLE
Middle Name:DONALD
Last Name:BROWN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 S JOPLIN
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3250 N PINAL PKWY
Practice Address - Street 2:PHS MEDICAL CLINIC
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-9459
Practice Address - Country:US
Practice Address - Phone:520-868-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist