Provider Demographics
NPI:1740589167
Name:BROWN, PETRA EMELINA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PETRA
Middle Name:EMELINA
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:P.O. BOX 643
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0643
Mailing Address - Country:US
Mailing Address - Phone:304-682-4703
Mailing Address - Fax:304-682-4544
Practice Address - Street 1:894 COOK PARKWAY
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870
Practice Address - Country:US
Practice Address - Phone:304-682-8586
Practice Address - Fax:304-682-4544
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist