Provider Demographics
NPI:1124391479
Name:BRIGHTON PHARMACY LLC
Entity Type:Organization
Organization Name:BRIGHTON PHARMACY LLC
Other - Org Name:BRIGHTON PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-226-0057
Mailing Address - Street 1:1403 W 10TH PL STE 119
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5252
Mailing Address - Country:US
Mailing Address - Phone:866-226-0057
Mailing Address - Fax:888-789-4573
Practice Address - Street 1:1403 W 10TH PL STE 119
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5252
Practice Address - Country:US
Practice Address - Phone:866-226-0057
Practice Address - Fax:888-789-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0054683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133845OtherPK