MEDICARE: DR. JUSTIN BROOKS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS40083	FL

General Provider Information

NPI Number	:	1033494570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN BROOKS PHARM.D.

Provider Business Mailing Address
First Line	:	4056 MEANDER PL UNIT 201
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4056 MEANDER PL UNIT 201
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5277
Country	:	US
Telephone Number	:	772-569-1414
Fax Number	:	772-569-5181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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