Provider Demographics
NPI:1386069177
Name:BRORBY, ALEXANDER (PHARM D)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BRORBY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 HOMER ADAMS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4856
Mailing Address - Country:US
Mailing Address - Phone:618-462-8223
Mailing Address - Fax:
Practice Address - Street 1:2851 HOMER ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4856
Practice Address - Country:US
Practice Address - Phone:618-462-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist