Provider Demographics
NPI:1497097323
Name:BROWN, AMY KATHLEEN (PHARMACIST CLINICIAN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMACIST CLINICIAN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BROWN
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1555 MESA VERDE E DR APT 58 I
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2307
Mailing Address - Country:US
Mailing Address - Phone:601-813-4955
Mailing Address - Fax:949-679-1905
Practice Address - Street 1:1555 MESA VERDE E DR APT 58 I
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2307
Practice Address - Country:US
Practice Address - Phone:601-813-4955
Practice Address - Fax:949-679-1905
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43131183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist