Provider Demographics
NPI:1366593170
Name:BROWN, EUGENE GLENN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:GLENN
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:108 E. HIGHWAY 74-76
Mailing Address - Street 2:P.O. BOX 148
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450
Mailing Address - Country:US
Mailing Address - Phone:910-646-3400
Mailing Address - Fax:910-646-4056
Practice Address - Street 1:108 E. HIGHWAY 74-76
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450
Practice Address - Country:US
Practice Address - Phone:910-646-3400
Practice Address - Fax:910-646-4056
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist