Individual
TIMOTHY DONALD BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
280 S IDAHO ST, WENDELL, ID 83355-5200
(208) 536-5761
(208) 536-5852
Mailing address
PO BOX 487, WENDELL, ID 83355-0487
(208) 536-5761
(208) 536-5852
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5751
ID
1835N0905X
Nuclear Pharmacist
P5751
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P5751
STATE LICENSE NUMBER
ID
Enumeration date
05/16/2013
Last updated
05/16/2013
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