Provider Demographics
NPI:1952700981
Name:BROWN, TIM (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
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 1:308 N AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3009
Mailing Address - Country:US
Mailing Address - Phone:225-647-0515
Mailing Address - Fax:225-644-0263
Practice Address - Street 1:308 N AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3009
Practice Address - Country:US
Practice Address - Phone:225-647-0515
Practice Address - Fax:225-644-0263
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist