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General NPI Number Information
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NPI Number | 1073892014
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Entity Type | Organization
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Legal Business Name | MYBRAND-RX LLC
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 159 GIBRALTAR RD
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City | HORSHAM
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State | PA
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Zip | 19044-2303
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Country | US
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Telephone | 855-899-4084
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Fax | 855-899-4090
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Provider Business Mailing Address
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Address Line | PO BOX 452
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-0452
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Country | US
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Telephone | 888-850-5545
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Fax | 888-651-4549
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MICHELE SHUBIN
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Credential |
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Telephone | 888-850-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PP482173
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License Number State | PA
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