Provider Demographics
NPI:1407824105
Name:BROWN, SHAWN WAYNE (RPH)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:WAYNE
Last Name:BROWN
Suffix:
Gender:M
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:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MO
Mailing Address - Zip Code:64644-1434
Mailing Address - Country:US
Mailing Address - Phone:816-583-2881
Mailing Address - Fax:816-583-2883
Practice Address - Street 1:500 1/2 DAVIS ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-1434
Practice Address - Country:US
Practice Address - Phone:816-583-2881
Practice Address - Fax:816-583-2883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBN8027105OtherDEA