=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770569501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY LEE BROWN PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 644 W LINE ST
-----------------------------------------------------
City | BISHOP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93514-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-872-2497
-----------------------------------------------------
Fax | 760-872-3935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2694 GLENBROOK WAY
-----------------------------------------------------
City | BISHOP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93514-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-873-7838
-----------------------------------------------------
Fax | 760-872-3935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 040214
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------