Provider Demographics
NPI:1518567742
Name:BROWN, DEBRA LYN
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6207
Mailing Address - Country:US
Mailing Address - Phone:405-640-3411
Mailing Address - Fax:
Practice Address - Street 1:2400 S COUNTRY CLUB RD STE 2
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5878
Practice Address - Country:US
Practice Address - Phone:405-262-6112
Practice Address - Fax:405-262-6343
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist