Provider Demographics
NPI:1801447214
Name:3 BROTHERS PHARMACY LLC
Entity type:Organization
Organization Name:3 BROTHERS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-934-9213
Mailing Address - Street 1:182 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4121
Mailing Address - Country:US
Mailing Address - Phone:662-934-9213
Mailing Address - Fax:
Practice Address - Street 1:645 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-5307
Practice Address - Country:US
Practice Address - Phone:662-934-9213
Practice Address - Fax:662-592-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy