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General NPI Number Information
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NPI Number | 1164904421
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Entity Type | Individual
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Provider Name | JASON BROOKS
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Gender | Male
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 310 VERNON AVE
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City | DENTON
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State | NC
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Zip | 27239-8913
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Country | US
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Telephone | 336-859-4572
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Fax |
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Provider Business Mailing Address
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Address Line | 251 BUSHNEY LOOP
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City | MOORESVILLE
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State | NC
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Zip | 28115-8100
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Country | US
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Telephone | 304-731-3454
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Fax |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 27496
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License Number State | NC
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