Healthcare Provider Details

I. General information

NPI: 1619009271
Provider Name (Legal Business Name): CAROL BROOKS REAGAN PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 BRYANT IRVIN ROAD N LL-STE. 215
FORT WORTH TX
76107
US

IV. Provider business mailing address

4701 BRYANT IRVIN RD N LL-STE. 215
FORT WORTH TX
76107-7627
US

V. Phone/Fax

Practice location:
  • Phone: 817-920-6875
  • Fax: 817-920-6748
Mailing address:
  • Phone: 817-920-6875
  • Fax: 817-920-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: