Healthcare Provider Details

I. General information

NPI: 1770715518
Provider Name (Legal Business Name): ETHEL ANN BROWN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 ROUTE 19 N
WARSAW NY
14569-9356
US

IV. Provider business mailing address

6295 BURKE HILL RD
PERRY NY
14530-9761
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0880
  • Fax: 585-786-0882
Mailing address:
  • Phone: 585-786-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: