Provider Demographics
NPI:1154402568
Name:BROWN, VERNA VITA (RPH)
Entity type:Individual
Prefix:MS
First Name:VERNA
Middle Name:VITA
Last Name:BROWN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E WOODROW WILSON AVE
Mailing Address - Street 2:(586/119)
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5116
Mailing Address - Country:US
Mailing Address - Phone:800-949-1009
Mailing Address - Fax:601-364-1578
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:(586/119)
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:800-949-1009
Practice Address - Fax:601-364-1578
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10794183500000X
MST-07760183500000X
IL051.039646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist