Provider Demographics
NPI:1548860489
Name:JACKSON-BROWN, DOROTHY (RPH)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:JACKSON-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 1:2911 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4312
Mailing Address - Country:US
Mailing Address - Phone:941-753-6764
Mailing Address - Fax:941-753-6751
Practice Address - Street 1:2911 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4312
Practice Address - Country:US
Practice Address - Phone:941-753-6764
Practice Address - Fax:941-753-6751
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0022440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist