Healthcare Provider Details

I. General information

NPI: 1124269378
Provider Name (Legal Business Name): BRABU PHARMACY AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AKARI BLDG CH PALE ARNOLD RD
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 10003 PMB 761
SAIPAN MP
96950-8903
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-2668
  • Fax: 670-233-2670
Mailing address:
  • Phone: 670-233-2668
  • Fax: 670-233-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-005
License Number StateMP

VIII. Authorized Official

Name: THEODORE PARKER
Title or Position: OWNER
Credential: R.PH., MPH
Phone: 670-233-2668