Provider Demographics
NPI:1871825109
Name:BROWN, RALPH WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:WALTER
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 1:2302 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2165
Mailing Address - Country:US
Mailing Address - Phone:803-366-6168
Mailing Address - Fax:803-366-6483
Practice Address - Street 1:2302 CHERRY RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2165
Practice Address - Country:US
Practice Address - Phone:803-366-6168
Practice Address - Fax:803-366-6483
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4814183500000X
NC9860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist