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General NPI Number Information
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NPI Number | 1669070157
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Entity Type | Individual
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Provider Name | AYESHA BROWN RPH
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 2030 E MAIN ST
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City | GALESBURG
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State | IL
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Zip | 61401-5460
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Country | US
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Telephone | 309-342-1619
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Fax | 309-342-2993
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Provider Business Mailing Address
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Address Line | 1706 BAIRD AVE
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City | GALESBURG
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State | IL
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Zip | 61401-6306
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Country | US
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Telephone | 786-325-1242
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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 | 051294188
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License Number State | IL
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