Provider Demographics
NPI:1790066173
Name:BROWN, EDWIN MACCLAIN (RPH)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:MACCLAIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15155 NW US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-8603
Mailing Address - Country:US
Mailing Address - Phone:386-418-3785
Mailing Address - Fax:386-418-4696
Practice Address - Street 1:15155 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8603
Practice Address - Country:US
Practice Address - Phone:386-418-3785
Practice Address - Fax:386-418-4696
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 18217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist