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General NPI Number Information
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NPI Number | 1821258807
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Entity Type | Organization
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Legal Business Name | BREVARD DRUG COMPANY LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 518 S BROAD ST
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City | BREVARD
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State | NC
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Zip | 28712-4438
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Country | US
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Telephone | 828-883-9757
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Fax | 828-883-2156
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Provider Business Mailing Address
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Address Line | 518 S BROAD ST
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City | BREVARD
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State | NC
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Zip | 28712-4438
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Country | US
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Telephone | 828-883-9757
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Fax | 828-883-2156
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY JACKSON
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Credential |
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Telephone | 828-883-9757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10409
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License Number State | NC
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