Provider Demographics
NPI:1023618345
Name:BROWN, PAUL GARRY (PD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:GARRY
Last Name:BROWN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8465
Mailing Address - Country:US
Mailing Address - Phone:870-972-1060
Mailing Address - Fax:
Practice Address - Street 1:1911 W PARKER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8465
Practice Address - Country:US
Practice Address - Phone:870-972-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist