Provider Demographics
NPI:1841298882
Name:BRENHAM DRUG PARTNERS LC
Entity type:Organization
Organization Name:BRENHAM DRUG PARTNERS LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-893-0677
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2407
Mailing Address - Country:US
Mailing Address - Phone:903-893-0677
Mailing Address - Fax:903-893-3639
Practice Address - Street 1:2103 S DAY ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5512
Practice Address - Country:US
Practice Address - Phone:979-836-8500
Practice Address - Fax:979-836-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX271313336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127786OtherPK
TX321022Medicaid
2127786OtherPK