Provider Demographics
NPI:1821412008
Name:BROWN, KIMBERLY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
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 1:3822 COLONEL GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9091
Mailing Address - Country:US
Mailing Address - Phone:937-426-3600
Mailing Address - Fax:
Practice Address - Street 1:3822 COLONEL GLENN HWY
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-9091
Practice Address - Country:US
Practice Address - Phone:937-426-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist