Healthcare Provider Details

I. General information

NPI: 1841942885
Provider Name (Legal Business Name): BROOKE TAYLOR PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE JUDGE PHAMD

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

815 QUEEN ANNE PL
SAINT LOUIS MO
63122-3143
US

V. Phone/Fax

Practice location:
  • Phone: 314-678-2177
  • Fax: 314-268-4069
Mailing address:
  • Phone: 314-681-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number2016021949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: