=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780272393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HENRY CHAPMAN BROWN III
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2021
-----------------------------------------------------
Last Update Date | 01/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 VADEN DR
-----------------------------------------------------
City | GRETNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24557-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 143-465-6125
-----------------------------------------------------
Fax | 434-656-6003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 456
-----------------------------------------------------
City | GRETNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24557-0456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-656-1251
-----------------------------------------------------
Fax | 434-656-6003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202006994
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------