1790942712 NPI number — CYNTHIA REGISTER BROWN RPH

Table of content: CYNTHIA REGISTER BROWN RPH (NPI 1790942712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790942712 NPI number — CYNTHIA REGISTER BROWN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CYNTHIA
Provider Middle Name:
REGISTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790942712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 CHADWICK SHORES DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNEADS FERRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-389-5724
Provider Business Mailing Address Fax Number:
910-329-0030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
REALO DISCOUNT DRUGS, 423 YOPP RD,
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-347-9684
Provider Business Practice Location Address Fax Number:
910-455-0622
Provider Enumeration Date:
05/19/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  10539 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)