Provider Demographics
NPI:1184733396
Name:THOMAS J BROWN JR
Entity type:Organization
Organization Name:THOMAS J BROWN JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-846-2202
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:KS
Mailing Address - Zip Code:67867-0128
Mailing Address - Country:US
Mailing Address - Phone:620-846-2202
Mailing Address - Fax:
Practice Address - Street 1:300 N AZTEC
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-0128
Practice Address - Country:US
Practice Address - Phone:620-846-2202
Practice Address - Fax:620-846-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS203995183500000X, 332B00000X
KS108493333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100445210AMedicaid
KS100445210AMedicaid