Healthcare Provider Details

I. General information

NPI: 1679762223
Provider Name (Legal Business Name): BENJAMIN KEITH BROWN D PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10703 DUTCHTOWN RD
KNOXVILLE TN
37932-3208
US

IV. Provider business mailing address

5603 VILLA RD
KNOXVILLE TN
37918-4441
US

V. Phone/Fax

Practice location:
  • Phone: 865-675-6444
  • Fax: 865-675-0412
Mailing address:
  • Phone: 865-689-1008
  • Fax: 865-675-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20088
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: