MEDICARE: BROOKE GRIFFIN 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
1	183500000X	Pharmacist	051289184	IL

General Provider Information

NPI Number	:	1962548271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE GRIFFIN PHARMD

Provider Business Mailing Address
First Line	:	1030 ERIE ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 31ST ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1235
Country	:	US
Telephone Number	:	630-515-7649
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/13/2013

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Directions to “ BROOKE GRIFFIN PHARMD” Practice Location

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