Provider Demographics
NPI:1083711923
Name:BROWN GARDINER DRUG CO INC
Entity Type:Organization
Organization Name:BROWN GARDINER DRUG CO INC
Other - Org Name:BROWN-GARDINER DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:336-273-0596
Mailing Address - Street 1:2101 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5111
Mailing Address - Country:US
Mailing Address - Phone:336-273-0596
Mailing Address - Fax:336-279-8354
Practice Address - Street 1:2101 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5111
Practice Address - Country:US
Practice Address - Phone:336-273-0596
Practice Address - Fax:336-279-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC045983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0415034Medicaid
2065920OtherPK
NC0415034Medicaid