Healthcare Provider Details

I. General information

NPI: 1285955831
Provider Name (Legal Business Name): MEAGAN MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-3048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: