Provider Demographics
NPI:1376796078
Name:BBRX3LLC
Entity Type:Organization
Organization Name:BBRX3LLC
Other - Org Name:KIDSRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:718-369-6100
Mailing Address - Street 1:189 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3013
Mailing Address - Country:US
Mailing Address - Phone:718-369-6100
Mailing Address - Fax:718-369-6101
Practice Address - Street 1:189 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3013
Practice Address - Country:US
Practice Address - Phone:718-369-6100
Practice Address - Fax:718-369-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029125OtherSTATE LICENSE