Healthcare Provider Details

I. General information

NPI: 1154402568
Provider Name (Legal Business Name): VERNA VITA BROWN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE (586/119)
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE (586/119)
JACKSON MS
39216-5116
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-1009
  • Fax: 601-364-1578
Mailing address:
  • Phone: 800-949-1009
  • Fax: 601-364-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10794
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-07760
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.039646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: