Healthcare Provider Details

I. General information

NPI: 1730319922
Provider Name (Legal Business Name): KENNETH ROBERT BROWN PHARMD.;PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 S STATE ST
OREM UT
84058-6308
US

IV. Provider business mailing address

495 UPPER EVERGREEN DR
PARK CITY UT
84098-5217
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-6650
  • Fax:
Mailing address:
  • Phone: 801-755-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5805551-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442994
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: