Provider Demographics
NPI:1861637738
Name:BROWN, BOBBY W
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:W
Last Name:BROWN
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:HALE CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:79041-0957
Mailing Address - Country:US
Mailing Address - Phone:806-839-2466
Mailing Address - Fax:806-839-3170
Practice Address - Street 1:601 AVENUE G
Practice Address - Street 2:
Practice Address - City:HALE CENTER
Practice Address - State:TX
Practice Address - Zip Code:79041
Practice Address - Country:US
Practice Address - Phone:806-839-2466
Practice Address - Fax:806-839-3170
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist