Provider Demographics
NPI:1295335594
Name:BROWN, KELLY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DRANE PL
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2534
Mailing Address - Country:US
Mailing Address - Phone:903-851-1301
Mailing Address - Fax:
Practice Address - Street 1:3801 W HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-9211
Practice Address - Country:US
Practice Address - Phone:903-874-8239
Practice Address - Fax:903-872-9522
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
TX42445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist