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General NPI Number Information
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NPI Number | 1073813275
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH BROOKS R.PH.
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Gender | Female
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 2103 VETERANS BLVD UNIT #2
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City | DUBLIN
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State | GA
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Zip | 31021
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Country | US
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Telephone | 478-274-5348
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Fax | 303-398-5262
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Provider Business Mailing Address
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Address Line | PO BOX 9000
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City | DUBLIN
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State | GA
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Zip | 31040
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Country | US
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Telephone | 478-246-3844
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Fax | 303-398-5262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS23723
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 015137
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License Number State | GA
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