Provider Demographics
NPI:1689744765
Name:BROWN & GOBIN INCORPORATED
Entity Type:Organization
Organization Name:BROWN & GOBIN INCORPORATED
Other - Org Name:MAUCH CHUNK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-486-8606
Mailing Address - Street 1:1204 NORTH ST
Mailing Address - Street 2:MCT PLAZA
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-1726
Mailing Address - Country:US
Mailing Address - Phone:570-325-5020
Mailing Address - Fax:570-325-5028
Practice Address - Street 1:1204 NORTH ST
Practice Address - Street 2:MCT PLAZA
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-1726
Practice Address - Country:US
Practice Address - Phone:570-325-5020
Practice Address - Fax:570-325-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415422L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2083885OtherPK
PA0017097890001Medicaid