Provider Demographics
NPI:1770715518
Name:BROWN, ETHEL ANN (RPH)
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:ANN
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 1:6295 BURKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530-9761
Mailing Address - Country:US
Mailing Address - Phone:585-786-3067
Mailing Address - Fax:
Practice Address - Street 1:2348 ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9356
Practice Address - Country:US
Practice Address - Phone:585-786-0880
Practice Address - Fax:585-786-0882
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist