Provider Demographics
NPI:1104921030
Name:BROWN, ROBERTA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:LYNN
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 1:10748 FOLKESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1376
Mailing Address - Country:US
Mailing Address - Phone:410-465-9598
Mailing Address - Fax:
Practice Address - Street 1:10748 FOLKESTONE WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1376
Practice Address - Country:US
Practice Address - Phone:410-465-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist