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NPI Code Detail

MEDICARE: EBONY BROOKS RPH

MEDICARE: EBONY BROOKS RPH
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
1183500000XPharmacist051298855IL

General Provider Information

NPI Number : 1144833195
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY BROOKS RPH
Provider Business Mailing Address
First Line : 2332 ROSE AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61102-3453
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1145 N ALPINE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-3613
Country : US
Telephone Number : 815-398-2443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 08/28/2020

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