Provider Demographics
NPI:1306284310
Name:BROWN, TONI MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:MARIE
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 1:4673 E 100 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5808
Mailing Address - Country:US
Mailing Address - Phone:208-403-4968
Mailing Address - Fax:
Practice Address - Street 1:3475 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6781
Practice Address - Country:US
Practice Address - Phone:208-227-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist