Provider Demographics
NPI:1669704862
Name:BROWN, DEIDRE FLEMING
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:FLEMING
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 ACORNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2271
Mailing Address - Country:US
Mailing Address - Phone:904-502-7455
Mailing Address - Fax:
Practice Address - Street 1:4645 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7324
Practice Address - Country:US
Practice Address - Phone:904-771-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29452183500000X
CA56906183500000X
GARPH025302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist