=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730319922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH ROBERT BROWN PHARMD.;PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2009
-----------------------------------------------------
Last Update Date | 07/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 774 S STATE ST
-----------------------------------------------------
City | OREM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84058-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-426-6650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 495 UPPER EVERGREEN DR
-----------------------------------------------------
City | PARK CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84098-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-755-4934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5805551-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP442994
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------