Provider Demographics
NPI:1467655472
Name:BROWN DRUG CO INC
Entity Type:Organization
Organization Name:BROWN DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-366-2425
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:MAPLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36750-0145
Mailing Address - Country:US
Mailing Address - Phone:334-366-2425
Mailing Address - Fax:334-366-2456
Practice Address - Street 1:9081 HWY 22 SOUTH
Practice Address - Street 2:
Practice Address - City:MAPLESVILLE
Practice Address - State:AL
Practice Address - Zip Code:36750
Practice Address - Country:US
Practice Address - Phone:334-366-2425
Practice Address - Fax:334-366-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1095983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122964OtherPK
AL115198Medicaid