Healthcare Provider Details

I. General information

NPI: 1073287744
Provider Name (Legal Business Name): BROWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 2ND ST NE CI
WATERTOWN SD
57201
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201
US

V. Phone/Fax

Practice location:
  • Phone: 605-753-7847
  • Fax: 605-884-4345
Mailing address:
  • Phone: 605-753-7847
  • Fax: 605-844-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROLE DEANN ANDERSON
Title or Position: OWNER/MANGER
Credential: RPH
Phone: 605-881-9673