Provider Demographics
NPI:1346852605
Name:BROWN, JULIA ROSE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
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 1:5111 W DOLPHIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4008
Mailing Address - Country:US
Mailing Address - Phone:843-530-9858
Mailing Address - Fax:
Practice Address - Street 1:9625 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3913
Practice Address - Country:US
Practice Address - Phone:843-818-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist