Provider Demographics
NPI:1275926297
Name:BROWN, PERRY WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:WAYNE
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 1:31960 TEMECULA PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5897
Mailing Address - Country:US
Mailing Address - Phone:951-303-1144
Mailing Address - Fax:
Practice Address - Street 1:31960 TEMECULA PKWY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5897
Practice Address - Country:US
Practice Address - Phone:951-303-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist