Provider Demographics
NPI:1699734962
Name:BROGDEN CORPORATION
Entity type:Organization
Organization Name:BROGDEN CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROGDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:336-644-7058
Mailing Address - Street 1:4446-C HIGHWAY 220 NORTH
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9414
Mailing Address - Country:US
Mailing Address - Phone:336-644-7058
Mailing Address - Fax:336-644-7297
Practice Address - Street 1:4446-C HIGHWAY 220 NORTH
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9414
Practice Address - Country:US
Practice Address - Phone:336-644-7058
Practice Address - Fax:336-644-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08993333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3402714OtherNCPDP
NC0418181Medicaid
NC0418181Medicaid
NC5485980001Medicare NSC