Provider Demographics
NPI:1821749987
Name:BRABU PHARMACY & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BRABU PHARMACY & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-233-2668
Mailing Address - Street 1:P.O. BOX 10003 PMB 761
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8903
Mailing Address - Country:US
Mailing Address - Phone:670-235-2668
Mailing Address - Fax:670-322-4898
Practice Address - Street 1:RJ COMMERCIAL CENTER ROUTE 31 DANDAN
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-2668
Practice Address - Fax:670-322-4898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRABU PHARMACY & WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy