NPIMap

Organization Active NPI

Brotherhood Pharmacy Inc

Doing business as Brotherhood Pharmacy

  • Community/Retail Pharmacy
  • Colton, CA
National Provider Identifier
1487296364
Registry record updated Oct 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROTHERHOOD PHARMACY INC
Doing business as
Brotherhood Pharmacy
Practice address
1040 S Mount Vernon Ave Ste E
Colton, CA 92324-4228
Phone
(909) 222-4884
Fax
(909) 222-4921
NPI assigned
Oct 12, 2019
Last updated
Oct 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yonghyun KimNPI 1316487986
Title
Owner
Phone
(909) 222-4884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1040 S Mount Vernon Ave Ste E
Colton, CA 92324-4228

Mailing address

1040 S Mount Vernon Ave Ste E
Colton, CA 92324-4228
Phone (909) 222-4884

Other names 1

  • BROTHERHOOD PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200110000444 CA Part B Supplier - Pharmacy 7113352626 Practice locations: Colton, CA

National Provider Directory

National Provider Directory
Tax ID family
Brotherhood Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1040 S Mount Vernon Ave
Ste E
Colton, CA 92324
Phone (909) 222-4884

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570838400000",
    "number": "1487296364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 S MOUNT VERNON AVE STE E",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244228",
            "telephone_number": "909-222-4884",
            "fax_number": "909-222-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 S MOUNT VERNON AVE STE E",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244228",
            "telephone_number": "909-222-4884",
            "fax_number": "909-222-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROTHERHOOD PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-12",
        "last_updated": "2019-10-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "YONGHYUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-222-4884"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROTHERHOOD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.