MEDICARE: BRIGHT MEDICAL TECHNOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP481246	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2086404	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619988284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MEDICAL TECHNOLOGY INC

Provider Business Mailing Address
First Line	:	2020 2040 NAPFLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152
Country	:	US
Telephone Number	:	215-942-7963
Fax Number	:	215-942-0438

Provider Business Practice Location Address
First Line	:	2020 2040 NAPFLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152
Country	:	US
Telephone Number	:	215-725-6337
Fax Number	:	215-725-7630

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER GOLDSMAN
Credential	:
Telephone Number	:	215-942-7963

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/13/2016

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