Provider Demographics
NPI:1740339688
Name:BROCKIE HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:BROCKIE HEALTHCARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-848-3445
Mailing Address - Street 1:PO BOX 5047
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17405-5047
Mailing Address - Country:US
Mailing Address - Phone:717-848-3445
Mailing Address - Fax:717-659-5051
Practice Address - Street 1:209 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-5321
Practice Address - Country:US
Practice Address - Phone:717-848-3445
Practice Address - Fax:717-659-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415001L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007508720009Medicaid
0363540001Medicare NSC
PA1007508720009Medicaid