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NPI Code Detail

MEDICARE: DR. DALLAS RAY BROOKS PHARMD

MEDICARE: DR. DALLAS RAY BROOKS PHARMD
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
1183500000XPharmacist22487NC

General Provider Information

NPI Number : 1609139682
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DALLAS RAY BROOKS PHARMD
Provider Business Mailing Address
First Line : 7140 HELENA MORIAH RD
Second Line :
City : ROUGEMONT
State : NC
Zip : 27572-7525
Country : US
Telephone Number : 336-364-2857
Fax Number :
Provider Business Practice Location Address
First Line : 304 N MADISON BLVD
Second Line :
City : ROXBORO
State : NC
Zip : 27573-5355
Country : US
Telephone Number : 336-599-0234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2012
Last Update Date : 06/24/2012

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