1962048397 NPI number — BRABU PHARMACY AND WELLNESS CENTER LLC

Table of content: (NPI 1962048397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962048397 NPI number — BRABU PHARMACY AND WELLNESS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRABU PHARMACY AND WELLNESS CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962048397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-233-2668
Provider Business Mailing Address Fax Number:
670-233-2670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KAGMAN III, RT 34
Provider Second Line Business Practice Location Address:
KAGMAN COMMERCIAL CENTER SUITE 3
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-256-2668
Provider Business Practice Location Address Fax Number:
670-233-2670
Provider Enumeration Date:
11/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MANAGING PARTNER/CO-OWNER
Authorized Official Telephone Number:
670-233-2668

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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