Provider Demographics
NPI:1790868636
Name:BROWN DRUG COMPANY
Entity Type:Organization
Organization Name:BROWN DRUG COMPANY
Other - Org Name:BROWN DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-1200
Mailing Address - Street 1:1121 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4040
Mailing Address - Country:US
Mailing Address - Phone:217-228-6430
Mailing Address - Fax:217-228-6423
Practice Address - Street 1:1121 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4040
Practice Address - Country:US
Practice Address - Phone:217-228-6430
Practice Address - Fax:217-228-6423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLESSING CORPORATE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IL054.0138293336C0003X
MO20001499823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790868636Medicaid
0708580001Medicare NSC