Healthcare Provider Details

I. General information

NPI: 1326089186
Provider Name (Legal Business Name): BROSSART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S MIAMI AVE
CLEVES OH
45002-1216
US

IV. Provider business mailing address

45 S MIAMI AVE
CLEVES OH
45002-1216
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-0428
  • Fax: 513-467-3512
Mailing address:
  • Phone: 513-941-0428
  • Fax: 513-467-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-16002
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN JOSEPH BROSSART
Title or Position: PRESIDENT
Credential: RPH
Phone: 513-941-0428