MEDICARE: BROTHERS PHARMACIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	1001897	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2094335	OTHER		PK

General Provider Information

NPI Number	:	1700836251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHERS PHARMACIES INC

Provider Business Mailing Address
First Line	:	213 E HUSTAN AVE STE A
Second Line	:
City	:	FORT PIERRE
State	:	SD
Zip	:	57532
Country	:	US
Telephone Number	:	605-223-9200
Fax Number	:	605-223-9201

Provider Business Practice Location Address
First Line	:	213 E HUSTAN AVE STE A
Second Line	:
City	:	FORT PIERRE
State	:	SD
Zip	:	57532
Country	:	US
Telephone Number	:	605-223-9200
Fax Number	:	605-223-9201

Authorized Official
Title or Position	:	CEO
Name	:	SHANE CLARAMBEAU
Credential	:	RPH
Telephone Number	:	605-223-9200

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/05/2021

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Directions to “BROTHERS PHARMACIES INC ” Practice Location

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