Provider Demographics
NPI:1023316262
Name:BROWN, CONNIE SMITH (RPH)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SMITH
Last Name:BROWN
Suffix:
Gender:F
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:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-0373
Mailing Address - Country:US
Mailing Address - Phone:770-574-3238
Mailing Address - Fax:
Practice Address - Street 1:633 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2359
Practice Address - Country:US
Practice Address - Phone:770-838-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist