Provider Demographics
NPI:1285001321
Name:BROWN, JORDAN KOLBY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:KOLBY
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:LUMBER CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31549-0128
Mailing Address - Country:US
Mailing Address - Phone:912-363-4979
Mailing Address - Fax:912-363-8453
Practice Address - Street 1:3316 E GOLDEN ISLES HWY
Practice Address - Street 2:
Practice Address - City:LUMBER CITY
Practice Address - State:GA
Practice Address - Zip Code:31549-3052
Practice Address - Country:US
Practice Address - Phone:912-363-4979
Practice Address - Fax:912-363-8453
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist