Provider Demographics
NPI:1700176724
Name:BROWN, JAMES E
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 E MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6307
Mailing Address - Country:US
Mailing Address - Phone:208-336-8890
Mailing Address - Fax:
Practice Address - Street 1:660 E BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5118
Practice Address - Country:US
Practice Address - Phone:208-336-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3399183500000X
OR5245183500000X
WAPH7901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist