Provider Demographics
NPI:1477574424
Name:PHARMAGEN LABORATORIES
Entity Type:Organization
Organization Name:PHARMAGEN LABORATORIES
Other - Org Name:BRYCE LABORATORIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-455-0207
Mailing Address - Street 1:30 BUXTON FARMS ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-359-6323
Mailing Address - Fax:203-359-6448
Practice Address - Street 1:30 BUXTON FARMS ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-359-6323
Practice Address - Fax:203-359-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00017733336C0004X
CTPCY.00017733336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0719130OtherNCPDP PROVIDER IDENTIFICATION NUMBER