Healthcare Provider Details

I. General information

NPI: 1588401327
Provider Name (Legal Business Name): MICHAEL RAY BROWN JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

IV. Provider business mailing address

616 SW 164TH TER
OKLAHOMA CITY OK
73170-7711
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number20274
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: