Provider Demographics
NPI:1619031424
Name:BROWN, GAYLA RENE' (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:RENE'
Last Name:BROWN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-0811
Mailing Address - Country:US
Mailing Address - Phone:770-867-6749
Mailing Address - Fax:770-967-0830
Practice Address - Street 1:5325 ATLANTA HIGHWAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:770-967-3325
Practice Address - Fax:770-967-0830
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist