| Organization Name: | BROCKWAY DRUG CO., INC. |
| NPI Number: | 1710995071 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD EDWARD MATSON (OWNER) |
| Mailing Address: | 1365 Main St Brockway |
| State: | PA US |
| Postal Code: | 158241635 |
| Phone Number: | 8142683305 |
| Fax Number: | 8142651143 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 02/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PP410257L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |