Provider Demographics
NPI:1639767213
Name:BROWN, JUSTIN (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NANCY LN
Mailing Address - Street 2:
Mailing Address - City:AXSON
Mailing Address - State:GA
Mailing Address - Zip Code:31624-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:813 PETERSON AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5234
Practice Address - Country:US
Practice Address - Phone:912-384-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist