Provider Demographics
NPI:1558318766
Name:BREHME DRUG INC
Entity Type:Organization
Organization Name:BREHME DRUG INC
Other - Org Name:BLAKESLY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREHME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-927-3509
Mailing Address - Street 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1733
Mailing Address - Country:US
Mailing Address - Phone:563-927-3509
Mailing Address - Fax:563-927-8849
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057
Practice Address - Country:US
Practice Address - Phone:563-927-3509
Practice Address - Fax:563-927-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA15923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167589OtherPK
IA0709534Medicaid
IA5733470001Medicare NSC
IA0178152Medicaid