Provider Demographics
NPI:1861623746
Name:BROWN TROUT LLC.
Entity type:Organization
Organization Name:BROWN TROUT LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CORDIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-321-9091
Mailing Address - Street 1:3704 N. NEVADA ST.
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2968
Mailing Address - Country:US
Mailing Address - Phone:509-489-4500
Mailing Address - Fax:509-489-4527
Practice Address - Street 1:906 S. MONROE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3836
Practice Address - Country:US
Practice Address - Phone:509-838-3145
Practice Address - Fax:509-489-4527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATES DRUG STORES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies