Provider Demographics
NPI:1114649969
Name:BROWN, KAMARISHA (CPHT)
Entity type:Individual
Prefix:
First Name:KAMARISHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 CHAPEL RIDGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2642
Mailing Address - Country:US
Mailing Address - Phone:314-853-6629
Mailing Address - Fax:
Practice Address - Street 1:190 N FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1942
Practice Address - Country:US
Practice Address - Phone:314-521-4518
Practice Address - Fax:314-524-6214
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017818183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician