Provider Demographics
NPI:1790841062
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:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-848-3445
Mailing Address - Street 1:118 PLEASANT ACRES RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8975
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 PLEASANT ACRES RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8975
Practice Address - Country:US
Practice Address - Phone:717-840-7144
Practice Address - Fax:717-757-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415755L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007508720013Medicaid
PA1007508720011Medicaid
3978600OtherOTHER ID NUMBER-COMMERCIAL NUMBER