Provider Demographics
NPI:1245870864
Name:BRAVO RX PHARMACY
Entity type:Organization
Organization Name:BRAVO RX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-426-0813
Mailing Address - Street 1:4125 W BROAD ST # B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1600
Mailing Address - Country:US
Mailing Address - Phone:614-426-0813
Mailing Address - Fax:614-426-0814
Practice Address - Street 1:4125 W BROAD ST # B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1600
Practice Address - Country:US
Practice Address - Phone:614-426-0813
Practice Address - Fax:614-426-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy