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General NPI Number Information
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NPI Number | 1154865822
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Entity Type | Individual
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Provider Name | ANNA BROOK RPH
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 5456 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-3453
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Country | US
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Telephone | 718-366-6900
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Fax | 718-366-6901
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Provider Business Mailing Address
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Address Line | 1717 E 18TH ST APT 5E
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City | BROOKLYN
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State | NY
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Zip | 11229-2147
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Country | US
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Telephone | 917-974-8312
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Fax | 718-366-6901
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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 | 062548
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License Number State | NY
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