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General NPI Number Information
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NPI Number | 1932642428
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Entity Type | Organization
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Legal Business Name | BROTHERS PHARMACIES INC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 213 E HUSTAN AVE STE A
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City | FORT PIERRE
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State | SD
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Zip | 57532
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Country | US
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Telephone | 605-223-9200
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Fax | 605-223-9201
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Provider Business Mailing Address
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Address Line | 213 E HUSTAN AVE STE A
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City | FORT PIERRE
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State | SD
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Zip | 57532
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Country | US
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Telephone | 605-223-9200
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Fax | 605-223-9201
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | SHANE CLARAMBEAU
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Credential |
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Telephone | 605-223-9200
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 100-1897
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License Number State | SD
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