Provider Demographics
NPI:1831224302
Name:BROOKNEAL DRUG CO INC
Entity type:Organization
Organization Name:BROOKNEAL DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:434-376-2220
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BROOKNEAL
Mailing Address - State:VA
Mailing Address - Zip Code:24528-0066
Mailing Address - Country:US
Mailing Address - Phone:434-376-2220
Mailing Address - Fax:434-376-3199
Practice Address - Street 1:120 RUSH STREET
Practice Address - Street 2:PHARMACY
Practice Address - City:BROOKNEAL
Practice Address - State:VA
Practice Address - Zip Code:24528-0066
Practice Address - Country:US
Practice Address - Phone:434-376-2220
Practice Address - Fax:434-376-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8502803Medicaid