Provider Demographics
NPI:1770830234
Name:BROWN, STACY JOHNSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JOHNSON
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 1:701 UNIVERSITY BLVD E STE M04
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7422
Mailing Address - Country:US
Mailing Address - Phone:205-750-0041
Mailing Address - Fax:205-750-0361
Practice Address - Street 1:701 UNIVERSITY BLVD E STE M04
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7422
Practice Address - Country:US
Practice Address - Phone:205-750-0041
Practice Address - Fax:205-750-0361
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist