Provider Demographics
NPI:1689772733
Name:BROWN, DIANA ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELIZABETH
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 1:467 REESE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRASSTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28902
Mailing Address - Country:US
Mailing Address - Phone:828-835-9235
Mailing Address - Fax:
Practice Address - Street 1:250 US HIGHWAY 64 EAST
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6892183500000X
GA11015183500000X
FLPS37776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist