=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619031424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAYLA RENE' BROWN RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5325 ATLANTA HIGHWAY
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-967-3325
-----------------------------------------------------
Fax | 770-967-0830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 811
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30011-0811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-867-6749
-----------------------------------------------------
Fax | 770-967-0830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 011666
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------