Provider Demographics
NPI:1124269378
Name:BRABU PHARMACY AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BRABU PHARMACY AND WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPH
Authorized Official - Phone:670-233-2668
Mailing Address - Street 1:PO BOX 10003
Mailing Address - Street 2:PMB 761
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8903
Mailing Address - Country:US
Mailing Address - Phone:670-233-2668
Mailing Address - Fax:670-233-2670
Practice Address - Street 1:101 AKARI BLDG CH PALE ARNOLD RD
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-233-2668
Practice Address - Fax:670-233-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MPRP-0053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119463OtherPK