MEDICARE: MR. EUGENE GLENN BROWN JR. RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5014	NC

General Provider Information

NPI Number	:	1366593170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE GLENN BROWN JR. RPH

Provider Business Mailing Address
First Line	:	108 E. HIGHWAY 74-76
Second Line	:	P.O. BOX 148
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450
Country	:	US
Telephone Number	:	910-646-3400
Fax Number	:	910-646-4056

Provider Business Practice Location Address
First Line	:	108 E. HIGHWAY 74-76
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450
Country	:	US
Telephone Number	:	910-646-3400
Fax Number	:	910-646-4056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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