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General NPI Number Information
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NPI Number | 1578059283
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Entity Type | Organization
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Legal Business Name | BRICKTOWNE PHARMACY LLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 2791 HOOPER AVE STORE #105
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City | BRICK
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State | NJ
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Zip | 08723
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Country | US
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Telephone | 848-241-9971
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Fax | 848-241-9970
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Provider Business Mailing Address
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Address Line | 1625 JACKS WAY
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City | TOMS RIVER
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State | NJ
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Zip | 08755
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Country | US
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Telephone | 848-241-9971
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Fax | 848-241-9970
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. KALU UDE NDUKWE
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Credential | RPH
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Telephone | 732-604-5576
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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 | NJ
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