Healthcare Provider Details

I. General information

NPI: 1710841465
Provider Name (Legal Business Name): ANDREA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CALDER AVE
AMERICAN FALLS ID
83211-1307
US

IV. Provider business mailing address

530 CALDER AVE
AMERICAN FALLS ID
83211-1307
US

V. Phone/Fax

Practice location:
  • Phone: 208-604-1784
  • Fax:
Mailing address:
  • Phone: 208-604-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7277
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: