Healthcare Provider Details

I. General information

NPI: 1841821816
Provider Name (Legal Business Name): BROOKS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 2ND AVE
ROCHELLE GA
31079-2046
US

IV. Provider business mailing address

PO BOX 157
ROCHELLE GA
31079-0157
US

V. Phone/Fax

Practice location:
  • Phone: 229-365-7447
  • Fax: 229-365-7552
Mailing address:
  • Phone: 229-365-7447
  • Fax: 229-365-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARSON BROOKS
Title or Position: OWNER
Credential:
Phone: 229-365-7447