Provider Demographics
NPI:1609012863
Name:BROWNSVILLE PHARMACY INC
Entity Type:Organization
Organization Name:BROWNSVILLE PHARMACY INC
Other - Org Name:BROWNSVILLE PHARMACY, MEDICINE SHOPPE 1961
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OHARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-745-6480
Mailing Address - Street 1:66 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1314
Mailing Address - Country:US
Mailing Address - Phone:724-745-6480
Mailing Address - Fax:724-745-8818
Practice Address - Street 1:27 MARKET ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-1787
Practice Address - Country:US
Practice Address - Phone:724-785-7095
Practice Address - Fax:724-785-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818903336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117785OtherPK