Healthcare Provider Details

I. General information

NPI: 1639238751
Provider Name (Legal Business Name): BRIGADOON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E UWCHLAN AVE
EXTON PA
19341-1207
US

IV. Provider business mailing address

200 E UWCHLAN AVE
EXTON PA
19341-1207
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-7474
  • Fax: 610-363-5707
Mailing address:
  • Phone: 610-363-7474
  • Fax: 610-363-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPP411861L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2083980
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: MICHAEL BRIGGS
Title or Position: PHARMACY MANAGER AND CO OWNER
Credential:
Phone: 610-363-7474