Provider Demographics
NPI:1649547720
Name:BROWN, NEIL L (RPH)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:L
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 1:690 MARTIN LUTHER KING JR BLVD N
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1626
Mailing Address - Country:US
Mailing Address - Phone:248-745-8495
Mailing Address - Fax:248-745-8367
Practice Address - Street 1:690 MARTIN LUTHER KING JR BLVD N
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1626
Practice Address - Country:US
Practice Address - Phone:248-745-8495
Practice Address - Fax:248-745-8367
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302017458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist