Provider Demographics
NPI:1467579839
Name:BRIGHTON-EGGERT PHARMACY INC
Entity Type:Organization
Organization Name:BRIGHTON-EGGERT PHARMACY INC
Other - Org Name:BRIGHTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-835-6778
Mailing Address - Street 1:935 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8113
Mailing Address - Country:US
Mailing Address - Phone:716-835-6778
Mailing Address - Fax:716-362-0985
Practice Address - Street 1:935 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8113
Practice Address - Country:US
Practice Address - Phone:716-835-6778
Practice Address - Fax:716-362-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0121253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00624617Medicaid
2059507OtherPK
0840880001Medicare NSC