Organization
BRISTER BROTHERS PHARMACY DME
Active
Parent organization
BRISTER BROTHERS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRISTER BROTHERS INC
Authorized official
MR. WARD BRISTER RPH (OWNER)
(662) 226-1642
Entity
Organization
Contact information
Practice address
1117 SUNSET DR, SUITE 102, GRENADA, MS 38901-4080
(662) 226-1642
(662) 226-8585
Mailing address
1117 SUNSET DR, SUITE 102, GRENADA, MS 38901-4080
(662) 226-1642
(662) 226-8585
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440562
—
MS
Enumeration date
05/14/2008
Last updated
05/14/2008
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