Healthcare Provider Details

I. General information

NPI: 1558421164
Provider Name (Legal Business Name): GREGORY S BROOKS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7172 COLUMBIA GATEWAY DR
COLUMBIA MD
21046-2990
US

IV. Provider business mailing address

3803 E JOPPA RD
NOTTINGHAM MD
21236-2204
US

V. Phone/Fax

Practice location:
  • Phone: 188-866-2677
  • Fax:
Mailing address:
  • Phone: 410-262-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11735
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number11735
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number18403
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302043576
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPD12444
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP0008642
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: