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General NPI Number Information
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NPI Number | 1558966630
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Entity Type | Individual
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Provider Name | SANDRA BROWN
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 101 BASKIN ST N
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City | UNION SPRINGS
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State | AL
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Zip | 36089-1504
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Country | US
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Telephone | 334-738-3140
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Fax | 334-738-3137
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Provider Business Mailing Address
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Address Line | 4526 COUNTY ROAD 37
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City | FITZPATRICK
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State | AL
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Zip | 36029-2907
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Country | US
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Telephone | 334-549-4029
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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 | 10427
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License Number State | AL
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