Healthcare Provider Details

I. General information

NPI: 1629590500
Provider Name (Legal Business Name): AMY EVELYN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 S LAKE DR
LEXINGTON SC
29073-7225
US

IV. Provider business mailing address

1856 S LAKE DR
LEXINGTON SC
29073-7225
US

V. Phone/Fax

Practice location:
  • Phone: 803-399-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37181
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: