=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437741774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM RUSSELL BROWN CPHT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2021
-----------------------------------------------------
Last Update Date | 02/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 JAMESTOWN RD
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-229-3560
-----------------------------------------------------
Fax | 757-253-5651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 RICHARDSON RUN APT G
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23188-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-778-4638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------