Provider Demographics
NPI:1285861310
Name:BROGDEN CORPORATION
Entity Type:Organization
Organization Name:BROGDEN CORPORATION
Other - Org Name:SUMMERFIELD PHARMACY IMMUNIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROGDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-644-7058
Mailing Address - Street 1:4446 US HIGHWAY 220 N STE C
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9415
Mailing Address - Country:US
Mailing Address - Phone:336-644-7058
Mailing Address - Fax:336-644-7297
Practice Address - Street 1:4446 US HIGHWAY 220 N STE C
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9415
Practice Address - Country:US
Practice Address - Phone:336-644-7058
Practice Address - Fax:336-644-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC089933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704343OtherMEDICAID DME
NC0418181Medicaid
NC7704343OtherMEDICAID DME