Provider Demographics
NPI:1487171039
Name:BROWN, ANNA BLAIR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:BLAIR
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 RIVER ROCK PL APT 104
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-6993
Mailing Address - Country:US
Mailing Address - Phone:601-946-1449
Mailing Address - Fax:
Practice Address - Street 1:984 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1509
Practice Address - Country:US
Practice Address - Phone:662-342-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41506183500000X
MSE-15002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist