NPIMap

Individual provider Active NPI

Eugene Glenn Brown Jr., RPH

  • Pharmacist
  • Lake Waccamaw, NC
National Provider Identifier
1366593170
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5014 Issued in NC
Practice address
108 E. Highway 74-76
Lake Waccamaw, NC 28450
Phone
(910) 646-3400
Fax
(910) 646-4056
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5014 NC Primary

Addresses

Primary practice location

108 E. Highway 74-76
Lake Waccamaw, NC 28450

Mailing address

108 E. Highway 74-76
P.O. Box 148
Lake Waccamaw, NC 28450
Phone (910) 646-3400

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5014NCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Egb Enterprises Inc Past Accepting new patients
Egb Enterjprises Past Accepting new patients
Blsrph, Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366593170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 E. HIGHWAY 74-76",
            "address_2": "P.O. BOX 148",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "28450",
            "telephone_number": "910-646-3400",
            "fax_number": "910-646-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E. HIGHWAY 74-76",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "28450",
            "telephone_number": "910-646-3400",
            "fax_number": "910-646-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "EUGENE",
        "middle_name": "GLENN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "5014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Waccamaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.