Provider Demographics
NPI:1477861417
Name:BROWEYED DRUGGIST, LLC
Entity Type:Organization
Organization Name:BROWEYED DRUGGIST, LLC
Other - Org Name:DBA ST. PARIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ RESPONSIBLE PERSON
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARAFA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH (PHARMACIST)
Authorized Official - Phone:937-663-6001
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:ST. PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072
Mailing Address - Country:US
Mailing Address - Phone:937-663-6001
Mailing Address - Fax:937-663-6003
Practice Address - Street 1:122 S. SPRINGFIELD ST.
Practice Address - Street 2:
Practice Address - City:ST. PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-7704
Practice Address - Country:US
Practice Address - Phone:937-663-6001
Practice Address - Fax:937-663-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OHRTP0223685503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144359OtherPK
OH0096996Medicaid