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General NPI Number Information
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NPI Number | 1730339565
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Entity Type | Individual
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Provider Name | MRS. LESA F BROOKMAN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 1561 VIRGINIA AVE
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City | RICH CREEK
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State | VA
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Zip | 24147
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Country | US
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Telephone | 540-726-7911
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Fax | 540-726-7980
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Provider Business Mailing Address
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Address Line | PO BOX 283
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City | RICH CREEK
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State | VA
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Zip | 24147-0283
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Country | US
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Telephone | 304-753-5008
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202011556
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License Number State | VA
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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 | RP0005661
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License Number State | WV
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