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General NPI Number Information
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NPI Number | 1467569863
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Entity Type | Individual
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Provider Name | BROOK SMITH DESRIVIERES PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 611 N SAINT JOSEPH AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-1832
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Country | US
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Telephone | 715-387-9916
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Fax | 715-387-7650
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Provider Business Mailing Address
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Address Line | 1113 S LOCUST AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-4033
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Country | US
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Telephone | 715-387-9916
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Fax | 715-387-7650
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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 | 03-01-27524
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License Number State | OH
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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 | 5302034164
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License Number State | MI
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