Provider Demographics
NPI:1497899447
Name:BROWN DRUG STORE INC
Entity Type:Organization
Organization Name:BROWN DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-746-3591
Mailing Address - Street 1:322 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2866
Mailing Address - Country:US
Mailing Address - Phone:505-746-3591
Mailing Address - Fax:505-746-6673
Practice Address - Street 1:322 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2866
Practice Address - Country:US
Practice Address - Phone:505-746-3591
Practice Address - Fax:505-746-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55210Medicaid