MEDICARE: JAN REYNOLDS BROWN 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	22306	TX

General Provider Information

NPI Number	:	1952902603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN REYNOLDS BROWN RPH

Provider Business Mailing Address
First Line	:	1014 COUNTY ROAD 182 E
Second Line	:
City	:	OVERTON
State	:	TX
Zip	:	75684-3176
Country	:	US
Telephone Number	:	903-985-0216
Fax Number	:	903-657-6697

Provider Business Practice Location Address
First Line	:	2121 US HIGHWAY 79 S
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-4405
Country	:	US
Telephone Number	:	903-657-2757
Fax Number	:	903-657-6697

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

Provider Enumeration Date	:	11/07/2020
Last Update Date	:	11/07/2020

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Directions to “ JAN REYNOLDS BROWN RPH” Practice Location

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