Provider Demographics
NPI:1790080935
Name:BROWER PHARMACY LLC
Entity Type:Organization
Organization Name:BROWER PHARMACY LLC
Other - Org Name:BROWER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:641-713-4381
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-0309
Mailing Address - Country:US
Mailing Address - Phone:641-713-4381
Mailing Address - Fax:641-713-2386
Practice Address - Street 1:140 W 4TH ST
Practice Address - Street 2:STE 3
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-1352
Practice Address - Country:US
Practice Address - Phone:641-713-4381
Practice Address - Fax:641-713-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA1773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1790080935Medicaid
2128446OtherPK