Provider Demographics
NPI:1811668791
Name:BROWN, MICHELLE ELISABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELISABETH
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 1:62 OWASCO ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4059
Mailing Address - Country:US
Mailing Address - Phone:315-252-9204
Mailing Address - Fax:
Practice Address - Street 1:62 OWASCO ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4059
Practice Address - Country:US
Practice Address - Phone:315-252-9452
Practice Address - Fax:315-453-1753
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0067945OtherSTATE LICENSE