Healthcare Provider Details

I. General information

NPI: 1871743039
Provider Name (Legal Business Name): TAMMY JANE BROOKMAN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

V. Phone/Fax

Practice location:
  • Phone: 937-473-3333
  • Fax:
Mailing address:
  • Phone: 937-473-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03318763
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9794
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: