Provider Demographics
NPI:1932642428
Name:BROTHERS PHARMACIES INC
Entity Type:Organization
Organization Name:BROTHERS PHARMACIES INC
Other - Org Name:SHANE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARAMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-223-9200
Mailing Address - Street 1:213 E HUSTAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532
Mailing Address - Country:US
Mailing Address - Phone:605-223-9200
Mailing Address - Fax:605-223-9201
Practice Address - Street 1:213 E HUSTAN AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57532
Practice Address - Country:US
Practice Address - Phone:605-223-9200
Practice Address - Fax:605-223-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SD100-18973336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8504350Medicaid
2166389OtherPK
5513090002Medicare NSC