Provider Demographics
NPI:1447661160
Name:BROOKS, LAURA A (RPH)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FARMRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9493
Mailing Address - Country:US
Mailing Address - Phone:937-748-0327
Mailing Address - Fax:
Practice Address - Street 1:3651 TOWNE BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5516
Practice Address - Country:US
Practice Address - Phone:513-424-2499
Practice Address - Fax:513-420-3965
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist