1871674028 NPI number — ANDREW BROWN'S DRUG STORE, INC.

Table of content: (NPI 1871674028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871674028 NPI number — ANDREW BROWN'S DRUG STORE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW BROWN'S DRUG STORE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871674028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 PITTSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18505-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-343-2442
Provider Business Mailing Address Fax Number:
570-346-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1789 N KEYSER AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-9618
Provider Business Practice Location Address Fax Number:
570-558-9686
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
570-343-2442

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  6000006622 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005764360004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com