Healthcare Provider Details

I. General information

NPI: 1265918940
Provider Name (Legal Business Name): ANDREW BROWN'S DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WASHINGTON AVE SUITE ONE
JERMYN PA
18433
US

IV. Provider business mailing address

5 WASHINGTON AVE SUITE ONE
JERMYN PA
18433
US

V. Phone/Fax

Practice location:
  • Phone: 570-230-6172
  • Fax:
Mailing address:
  • Phone: 570-230-6172
  • Fax: 570-230-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP482800L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL BROWN
Title or Position: PRESIDENT
Credential:
Phone: 570-840-8600