Provider Demographics
NPI:1558966630
Name:BROWN, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:4526 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:FITZPATRICK
Mailing Address - State:AL
Mailing Address - Zip Code:36029-2907
Mailing Address - Country:US
Mailing Address - Phone:334-549-4029
Mailing Address - Fax:
Practice Address - Street 1:101 BASKIN ST N
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1504
Practice Address - Country:US
Practice Address - Phone:334-738-3140
Practice Address - Fax:334-738-3137
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist