Provider Demographics
NPI:1811087943
Name:BRANDTS DRUGS
Entity type:Organization
Organization Name:BRANDTS DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-839-7207
Mailing Address - Street 1:BOX 651
Mailing Address - Street 2:1964 SO. MOREY RD
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-9380
Mailing Address - Country:US
Mailing Address - Phone:231-839-7207
Mailing Address - Fax:231-839-4142
Practice Address - Street 1:1964 SO. MOREY RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-9380
Practice Address - Country:US
Practice Address - Phone:231-839-7207
Practice Address - Fax:231-839-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301003542333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0191450001Medicare NSC