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General NPI Number Information
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NPI Number | 1124391479
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Entity Type | Organization
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Legal Business Name | BRIGHTON PHARMACY LLC
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 1403 W 10TH PL STE 119
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City | TEMPE
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State | AZ
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Zip | 85281-5252
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Country | US
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Telephone | 866-226-0057
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Fax | 888-789-4573
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Provider Business Mailing Address
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Address Line | 1403 W 10TH PL STE 119
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City | TEMPE
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State | AZ
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Zip | 85281-5252
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Country | US
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Telephone | 866-226-0057
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Fax | 888-789-4573
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Authorized Official
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Title or Position | PIC
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Name | JEFFREY GUBERNICK
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Credential |
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Telephone | 866-226-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y005468
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License Number State | AZ
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