Provider Demographics
NPI:1447767629
Name:BROWN, FRED
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 DIRECTORS ROW
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38131-0405
Mailing Address - Country:US
Mailing Address - Phone:901-346-4306
Mailing Address - Fax:901-346-4308
Practice Address - Street 1:3171 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0405
Practice Address - Country:US
Practice Address - Phone:901-346-4306
Practice Address - Fax:901-346-4308
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist