Provider Demographics
NPI:1588867519
Name:BROWNS PHARMACY INC
Entity type:Organization
Organization Name:BROWNS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-663-7707
Mailing Address - Street 1:375 TRIMMER LANE
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-7428
Mailing Address - Country:US
Mailing Address - Phone:573-663-7707
Mailing Address - Fax:573-663-7212
Practice Address - Street 1:375 TRIMMER LANE
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-7428
Practice Address - Country:US
Practice Address - Phone:573-663-7707
Practice Address - Fax:573-663-7212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWNS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO20030272513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620057208Medicaid
MO5131390001Medicare NSC