Provider Demographics
NPI:1679762223
Name:BROWN, BENJAMIN KEITH (D PH)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KEITH
Last Name:BROWN
Suffix:
Gender:M
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4441
Mailing Address - Country:US
Mailing Address - Phone:865-689-1008
Mailing Address - Fax:865-675-0412
Practice Address - Street 1:10703 DUTCHTOWN RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3208
Practice Address - Country:US
Practice Address - Phone:865-675-6444
Practice Address - Fax:865-675-0412
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20088183500000X
TN4262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist