Provider Demographics
NPI:1871674028
Name:ANDREW BROWN'S DRUG STORE, INC.
Entity Type:Organization
Organization Name:ANDREW BROWN'S DRUG STORE, INC.
Other - Org Name:ANDREW BROWN'S HOME HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHA
Authorized Official - Phone:570-343-2442
Mailing Address - Street 1:1502 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1668
Mailing Address - Country:US
Mailing Address - Phone:570-343-2442
Mailing Address - Fax:570-346-5887
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1250
Practice Address - Country:US
Practice Address - Phone:570-558-9618
Practice Address - Fax:570-558-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006622332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005764360004Medicaid
0210170003Medicare NSC