Healthcare Provider Details

I. General information

NPI: 1669549150
Provider Name (Legal Business Name): BROWNS DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN
DERBY LINE VT
05830
US

IV. Provider business mailing address

416 CHALAN SAN ANTONIO
TAMUNING GU
96913-3601
US

V. Phone/Fax

Practice location:
  • Phone: 802-873-3122
  • Fax: 802-873-9226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY015
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JULIUS FERNANDO
Title or Position: PIC
Credential: RPH
Phone: 671-649-1977