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General NPI Number Information
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NPI Number | 1306046800
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Entity Type | Organization
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Legal Business Name | BRACE RD SUPERMARKET, LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 1445 BRACE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3535
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Country | US
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Telephone | 856-216-7710
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 BRACE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3535
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Country | US
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Telephone | 856-216-7710
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Fax |
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Authorized Official
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Title or Position | THIRD PARTY/PHARMACY SYSTEMS ADMIN
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Name | MONA GADKARI
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Credential |
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Telephone | 732-521-8448
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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 |
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License Number State |
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