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General NPI Number Information
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NPI Number | 1386903391
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Entity Type | Organization
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Legal Business Name | BRUNSWICK SQUARE PHARMACY
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1177 STATE ROUTE 18
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4935
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Country | US
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Telephone | 732-257-5200
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Fax | 732-257-2600
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Provider Business Mailing Address
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Address Line | 12 BEVERLY RD
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-1614
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Country | US
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Telephone | 732-257-5200
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Fax | 732-257-2600
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIAN MIKAILLE
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Credential |
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Telephone | 201-726-3033
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00718900
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License Number State | NJ
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