Healthcare Provider Details

I. General information

NPI: 1649382128
Provider Name (Legal Business Name): TWO BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 NORWICH AVE
FRANKLIN FURNACE OH
45629-8892
US

IV. Provider business mailing address

561 NORWICH AVE
FRANKLIN FURNACE OH
45629-8892
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-9984
  • Fax: 740-354-9978
Mailing address:
  • Phone: 740-354-9984
  • Fax: 740-354-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020961900-03
License Number StateOH

VIII. Authorized Official

Name: MARTIN RUSSELL
Title or Position: OWNER/PIC/AO
Credential: RPH
Phone: 740-354-9984