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General NPI Number Information
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NPI Number | 1245828961
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Entity Type | Individual
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Provider Name | JACOB M BROWN CPHT
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Gender | Male
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 650 S TRUMAN BLVD
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City | FESTUS
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State | MO
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Zip | 63028-2235
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Country | US
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Telephone | 636-937-9406
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 EDGEWOOD DR
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City | FESTUS
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State | MO
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Zip | 63028-3407
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Country | US
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Telephone | 636-524-9883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 2019011615
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License Number State | MO
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