Provider Demographics
NPI:1821665837
Name:BROWNSBERGER, EVAN MICHAEL
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MICHAEL
Last Name:BROWNSBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3820
Mailing Address - Country:US
Mailing Address - Phone:734-663-1362
Mailing Address - Fax:734-663-0445
Practice Address - Street 1:2603 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3820
Practice Address - Country:US
Practice Address - Phone:734-663-1362
Practice Address - Fax:734-663-0445
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303035966183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician