Provider Demographics
NPI:1609432459
Name:BRX LLC
Entity type:Organization
Organization Name:BRX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELLDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-276-5066
Mailing Address - Street 1:38 LONE PINE DR
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-8604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1744
Practice Address - Country:US
Practice Address - Phone:304-842-7979
Practice Address - Fax:304-848-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy