Provider Demographics
NPI:1447528401
Name:BROWN, KERRY E (RPH)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:E
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 1:726 S 400 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6322
Mailing Address - Country:US
Mailing Address - Phone:801-221-9355
Mailing Address - Fax:801-221-3706
Practice Address - Street 1:726 S 400 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6322
Practice Address - Country:US
Practice Address - Phone:801-221-9355
Practice Address - Fax:801-221-3706
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151432-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT151432-1701OtherSTATE OF UTAH DEPARTMENT OF COMMERCE