MEDICARE: AMY EVELYN BROWN

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	37181	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37181	OTHER	SC	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1629590500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY EVELYN BROWN

Provider Business Mailing Address
First Line	:	1856 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7225
Country	:	US
Telephone Number	:	803-399-7701
Fax Number	:

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

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	07/12/2017

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