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General NPI Number Information
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NPI Number | 1659550176
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Entity Type | Organization
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Legal Business Name | BROTHERS HEALTHCARE INC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 11705 SLATE AVE STE 250
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City | RIVERSIDE
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State | CA
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Zip | 92505-7120
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Country | US
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Telephone | 909-792-2300
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Fax | 909-792-7171
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Provider Business Mailing Address
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Address Line | 11705 SLATE AVE STE 250
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City | RIVERSIDE
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State | CA
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Zip | 92505-7120
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Country | US
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Telephone | 909-792-2300
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Fax | 909-792-7171
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN SHAUGHNESSY
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Credential |
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Telephone | 909-792-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY52529
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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