Provider Demographics
NPI:1629133046
Name:BROCKIE HEALTHCARE INC
Entity Type:Organization
Organization Name:BROCKIE HEALTHCARE INC
Other - Org Name:BROCKIE PHARMATECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-848-3445
Mailing Address - Street 1:100 HOMEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7860
Mailing Address - Country:US
Mailing Address - Phone:717-632-5000
Mailing Address - Fax:717-637-5020
Practice Address - Street 1:100 HOMEWOOD WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7860
Practice Address - Country:US
Practice Address - Phone:717-632-5000
Practice Address - Fax:717-637-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4814823336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087369OtherPK
PA1007508270014Medicaid
PA1007508270014Medicaid