Provider Demographics
NPI:1821396060
Name:BROWN, MIRANDA IVEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:IVEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CLYDE SHORT RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-3839
Mailing Address - Country:US
Mailing Address - Phone:706-654-1700
Mailing Address - Fax:
Practice Address - Street 1:3330 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4005
Practice Address - Country:US
Practice Address - Phone:770-904-7188
Practice Address - Fax:770-904-7193
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist