Provider Demographics
NPI:1578298659
Name:WEBER, BRANDON WILLIAM
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 FARNSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1869
Mailing Address - Country:US
Mailing Address - Phone:609-298-7773
Mailing Address - Fax:
Practice Address - Street 1:338 FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1869
Practice Address - Country:US
Practice Address - Phone:609-298-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW04101200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician