Provider Demographics
NPI:1578059283
Name:BRICKTOWNE PHARMACY LLC
Entity Type:Organization
Organization Name:BRICKTOWNE PHARMACY LLC
Other - Org Name:PERSONAL TOUCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KALU
Authorized Official - Middle Name:UDE
Authorized Official - Last Name:NDUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-604-5576
Mailing Address - Street 1:1625 JACKS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:848-241-9971
Mailing Address - Fax:848-241-9970
Practice Address - Street 1:2791 HOOPER AVE
Practice Address - Street 2:STORE #105
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:848-241-9971
Practice Address - Fax:848-241-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy