Provider Demographics
NPI:1780295865
Name:BROWN, GARY D (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:D
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 1:1045 S GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3501
Mailing Address - Country:US
Mailing Address - Phone:586-954-4905
Mailing Address - Fax:586-954-4938
Practice Address - Street 1:1045 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3501
Practice Address - Country:US
Practice Address - Phone:586-954-4905
Practice Address - Fax:586-954-4938
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist