Provider Demographics
NPI:1669532412
Name:BRIGHTON PHARMACY INC
Entity type:Organization
Organization Name:BRIGHTON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:CLAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-659-1900
Mailing Address - Street 1:1929 E EGBERT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2409
Mailing Address - Country:US
Mailing Address - Phone:303-659-1900
Mailing Address - Fax:303-659-7743
Practice Address - Street 1:1929 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2409
Practice Address - Country:US
Practice Address - Phone:303-659-1900
Practice Address - Fax:303-659-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03096815Medicaid
BB3974400OtherDEA NUMBER