Provider Demographics
NPI:1265918940
Name:ANDREW BROWN'S DRUG STORE, INC.
Entity type:Organization
Organization Name:ANDREW BROWN'S DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-840-8600
Mailing Address - Street 1:5 WASHINGTON AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433
Mailing Address - Country:US
Mailing Address - Phone:570-230-6172
Mailing Address - Fax:570-230-6178
Practice Address - Street 1:5 WASHINGTON AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433
Practice Address - Country:US
Practice Address - Phone:570-230-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482800L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy