Provider Demographics
NPI:1013135045
Name:BROWN, JENNIFER R
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 GUNTERS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:GALIVANTS FERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29544-8810
Mailing Address - Country:US
Mailing Address - Phone:843-358-2643
Mailing Address - Fax:
Practice Address - Street 1:725 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511
Practice Address - Country:US
Practice Address - Phone:843-358-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist