Provider Demographics
NPI:1801500954
Name:BRIGHTON OAKS PHARMACY LLC
Entity type:Organization
Organization Name:BRIGHTON OAKS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UGWUMSIACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:IBIAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:781-363-0186
Mailing Address - Street 1:4450 BENTON MILL DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3568
Mailing Address - Country:US
Mailing Address - Phone:781-363-0186
Mailing Address - Fax:
Practice Address - Street 1:1208 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4417
Practice Address - Country:US
Practice Address - Phone:919-240-4772
Practice Address - Fax:919-240-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy