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General NPI Number Information
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NPI Number | 1386244911
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Entity Type | Individual
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Provider Name | NATHAN BROWN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 11/01/2020
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Provider Practice Location Address
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Address Line | 1941 W MORTON AVE
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2620
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Country | US
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Telephone | 217-245-5815
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 OUTER PARK DR APT 9
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4421
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Country | US
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Telephone | 217-741-9636
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.302938
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License Number State | IL
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