Provider Demographics
NPI:1871544023
Name:BROOKS PHARMACY INC
Entity type:Organization
Organization Name:BROOKS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-749-8113
Mailing Address - Street 1:585 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4241
Mailing Address - Country:US
Mailing Address - Phone:860-749-8113
Mailing Address - Fax:860-749-7403
Practice Address - Street 1:585 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4241
Practice Address - Country:US
Practice Address - Phone:860-749-8113
Practice Address - Fax:860-749-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT453333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy