Healthcare Provider Details

I. General information

NPI: 1699734962
Provider Name (Legal Business Name): BROGDEN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4446-C HIGHWAY 220 NORTH
SUMMERFIELD NC
27358-9414
US

IV. Provider business mailing address

4446-C HIGHWAY 220 NORTH
SUMMERFIELD NC
27358-9414
US

V. Phone/Fax

Practice location:
  • Phone: 336-644-7058
  • Fax: 336-644-7297
Mailing address:
  • Phone: 336-644-7058
  • Fax: 336-644-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number08993
License Number StateNC

VIII. Authorized Official

Name: MR. HARRY LEE BROGDEN JR.
Title or Position: OWNER/PHARMACY MANAGER
Credential: BS PHARMACY
Phone: 336-644-7058