Provider Demographics
NPI:1831258219
Name:BREWIS PHARMACY INC
Entity type:Organization
Organization Name:BREWIS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNDELL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BREWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-798-2740
Mailing Address - Street 1:1548 FORESTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214
Mailing Address - Country:US
Mailing Address - Phone:205-798-2740
Mailing Address - Fax:205-791-0025
Practice Address - Street 1:1548 FORESTDALE BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214
Practice Address - Country:US
Practice Address - Phone:205-798-2740
Practice Address - Fax:205-791-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1109863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110986OtherALA STATE BD OF PHARM
0104620OtherNABP