Provider Demographics
NPI:1891838959
Name:BREWER DRUGS INC
Entity Type:Organization
Organization Name:BREWER DRUGS INC
Other - Org Name:BEAUTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHRM
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-649-3923
Mailing Address - Street 1:124 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63845-1140
Mailing Address - Country:US
Mailing Address - Phone:573-649-3923
Mailing Address - Fax:573-649-3761
Practice Address - Street 1:124 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63845-1140
Practice Address - Country:US
Practice Address - Phone:573-649-3923
Practice Address - Fax:573-649-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO20060294843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600098404Medicaid
2048850OtherPK
MO600098404Medicaid