Healthcare Provider Details

I. General information

NPI: 1619899697
Provider Name (Legal Business Name): GAITHERSBURG RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RUSSELL AVE STE 100
GAITHERSBURG MD
20877-2815
US

IV. Provider business mailing address

241 1ST ST
LAKEWOOD NJ
08701-3320
US

V. Phone/Fax

Practice location:
  • Phone: 301-216-5216
  • Fax:
Mailing address:
  • Phone: 732-276-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HILLEL BRULL
Title or Position: CEO
Credential:
Phone: 732-276-1551