MEDICARE: BROTHERS PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1366138943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHERS PHARMACY LLC

Provider Business Mailing Address
First Line	:	11705 SLATE AVE STE 200
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-5199
Country	:	US
Telephone Number	:	951-809-4011
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 LESLIE LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70615-4772
Country	:	US
Telephone Number	:	877-264-8060
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF REIMBURSEMENT
Name	:	JENNIFER ARNOLD
Credential	:
Telephone Number	:	951-809-4011

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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Directions to “BROTHERS PHARMACY LLC ” Practice Location

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