Provider Demographics
NPI:1437704475
Name:BROWN, DUSTIN LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LEE
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 451
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0451
Mailing Address - Country:US
Mailing Address - Phone:812-988-7463
Mailing Address - Fax:
Practice Address - Street 1:292 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7038
Practice Address - Country:US
Practice Address - Phone:812-988-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021820A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist