Provider Demographics
NPI:1881038651
Name:BROWN, KATIE MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 60 E BOX 847
Mailing Address - Street 2:
Mailing Address - City:GAULEY BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25085
Mailing Address - Country:US
Mailing Address - Phone:304-632-2217
Mailing Address - Fax:304-632-1004
Practice Address - Street 1:RT 60 E BOX 847
Practice Address - Street 2:
Practice Address - City:GAULEY BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25085
Practice Address - Country:US
Practice Address - Phone:304-632-2217
Practice Address - Fax:304-632-1004
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist