Healthcare Provider Details

I. General information

NPI: 1477861417
Provider Name (Legal Business Name): BROWEYED DRUGGIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S. SPRINGFIELD ST.
ST. PARIS OH
43072-7704
US

IV. Provider business mailing address

PO BOX 586
ST. PARIS OH
43072
US

V. Phone/Fax

Practice location:
  • Phone: 937-663-6001
  • Fax: 937-663-6003
Mailing address:
  • Phone: 937-663-6001
  • Fax: 937-663-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP022368550
License Number StateOH

VIII. Authorized Official

Name: CRAIG A CARAFA
Title or Position: OWNER/ RESPONSIBLE PERSON
Credential: RPH (PHARMACIST)
Phone: 937-663-6001