Provider Demographics
NPI:1295953255
Name:BROTHERS, GARY MALCOLM (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MALCOLM
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 INNSBRUCK RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3055
Mailing Address - Country:US
Mailing Address - Phone:315-656-7339
Mailing Address - Fax:
Practice Address - Street 1:833 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1507
Practice Address - Country:US
Practice Address - Phone:315-476-9246
Practice Address - Fax:315-476-6421
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist