Provider Demographics
NPI:1033404686
Name:BROOKS, EARL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 GARNERS FERRY RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0600
Mailing Address - Country:US
Mailing Address - Phone:803-783-3752
Mailing Address - Fax:803-783-3752
Practice Address - Street 1:6090 GARNERS FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-0600
Practice Address - Country:US
Practice Address - Phone:803-783-3752
Practice Address - Fax:803-783-3752
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist