Provider Demographics
NPI:1073637963
Name:BROWN, RAY EUGENE (DPH)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:EUGENE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W WHITNEY CIR
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1754
Mailing Address - Country:US
Mailing Address - Phone:865-983-1451
Mailing Address - Fax:
Practice Address - Street 1:2135 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3034
Practice Address - Country:US
Practice Address - Phone:865-981-4338
Practice Address - Fax:865-981-4347
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist