Basic Information
| Provider Information | |||||||||
| NPI: | 1255932125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | EDEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 VIOLET ST | ||||||||
| Address2: | |||||||||
| City: | COCHRAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310146816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293150700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 366 GA HIGHWAY 26 E | ||||||||
| Address2: | |||||||||
| City: | COCHRAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310146049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789344735 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2020 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH029261 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.