Healthcare Provider Details

I. General information

NPI: 1184733396
Provider Name (Legal Business Name): THOMAS J BROWN JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N AZTEC
MONTEZUMA KS
67867-0128
US

IV. Provider business mailing address

PO BOX 128
MONTEZUMA KS
67867-0128
US

V. Phone/Fax

Practice location:
  • Phone: 620-846-2202
  • Fax: 620-846-7130
Mailing address:
  • Phone: 620-846-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203995
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number108493
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number203995
License Number StateKS

VIII. Authorized Official

Name: MR. THOMAS J BROWN JR.
Title or Position: OWNER
Credential: RPH
Phone: 620-846-2202