Provider Demographics
NPI:1326089186
Name:BROSSART INC
Entity Type:Organization
Organization Name:BROSSART INC
Other - Org Name:BROSSART PHARAMCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROSSART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-941-0428
Mailing Address - Street 1:45 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1216
Mailing Address - Country:US
Mailing Address - Phone:513-941-0428
Mailing Address - Fax:513-467-3512
Practice Address - Street 1:45 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-1216
Practice Address - Country:US
Practice Address - Phone:513-941-0428
Practice Address - Fax:513-467-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2011101Medicaid
OH0589750001Medicare ID - Type Unspecified