Provider Demographics
NPI:1417592098
Name:BROWN, EMILY (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
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 68
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62476-0068
Mailing Address - Country:US
Mailing Address - Phone:618-456-3716
Mailing Address - Fax:618-456-2029
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:IL
Practice Address - Zip Code:62476-1202
Practice Address - Country:US
Practice Address - Phone:618-456-3716
Practice Address - Fax:618-456-2029
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist