Provider Demographics
NPI:1477183580
Name:BROWN, DEZMOND (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEZMOND
Middle Name:
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 1:1098 KELTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1728
Mailing Address - Country:US
Mailing Address - Phone:614-378-2972
Mailing Address - Fax:
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3733
Practice Address - Country:US
Practice Address - Phone:740-452-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist