Provider Demographics
NPI:1750159281
Name:BRIGHTRX
Entity type:Organization
Organization Name:BRIGHTRX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGASSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:757-243-7793
Mailing Address - Street 1:6100 WESTCHESTER PARK DR STE C1
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:240-696-4005
Mailing Address - Fax:240-696-4382
Practice Address - Street 1:6100 WESTCHESTER PARK DR STE C1
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:240-696-4005
Practice Address - Fax:240-696-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy