Provider Demographics
NPI:1891886776
Name:BROWN, JENNIFER G (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10511 DIBERVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-2403
Mailing Address - Country:US
Mailing Address - Phone:228-218-5461
Mailing Address - Fax:
Practice Address - Street 1:10511 DIBERVILLE BLVD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2403
Practice Address - Country:US
Practice Address - Phone:228-218-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2519758Medicare UPIN