Healthcare Provider Details

I. General information

NPI: 1114526449
Provider Name (Legal Business Name): BROOKE LEILA RASGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 S CLOVIS AVE
FRESNO CA
93727-4511
US

IV. Provider business mailing address

150 N BURL AVE
FRESNO CA
93727-6825
US

V. Phone/Fax

Practice location:
  • Phone: 559-251-0163
  • Fax:
Mailing address:
  • Phone: 209-276-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: