Provider Demographics
NPI:1588741540
Name:ANDREW BROWN'S DRUG STORE, INC.
Entity type:Organization
Organization Name:ANDREW BROWN'S DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHA
Authorized Official - Phone:570-343-2442
Mailing Address - Street 1:1502 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1668
Mailing Address - Country:US
Mailing Address - Phone:570-346-7319
Mailing Address - Fax:570-343-5850
Practice Address - Street 1:1502 PITTSTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1668
Practice Address - Country:US
Practice Address - Phone:570-346-7319
Practice Address - Fax:570-343-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410271L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3908843OtherNABP NUMBER
PA0005764360002Medicaid
0210170002Medicare NSC