Individual provider Active NPI

Jeremy Brown, PHARMD

  • Pharmacist
  • Coos Bay, OR
National Provider Identifier
1093095259
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH-0016701 Issued in OR
Practice address
1775 Thompson Rd
Coos Bay, OR 97420-2198
Phone
(541) 269-8489
Fax
(912) 265-0956
NPI assigned
Aug 19, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH025976 GA
Pharmacist 183500000X RPH-0016701 OR Primary

Addresses

Primary practice location

1775 Thompson Rd
Coos Bay, OR 97420-2198

Mailing address

1775 Thompson Rd
Coos Bay, OR 97420-2198
Phone (541) 269-8489

Other identifiers 2

IdentifierTypeStateIssuer
RPH025976OtherGAGEORGIA STATE PHARMACY LICENSE
RPH-0016701OtherOROREGON BOARD OF PHARMACY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RPH025976GAMDPharmacist
RPH-0016701ORMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1093095259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202198",
            "telephone_number": "541-269-8489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202198",
            "telephone_number": "541-269-8489",
            "fax_number": "912-265-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-19",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH025976",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0016701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA STATE PHARMACY LICENSE",
            "identifier": "RPH025976",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF PHARMACY",
            "identifier": "RPH-0016701",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.