Provider Demographics
NPI:1043524820
Name:BROOKS, LAYTON NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAYTON
Middle Name:NICOLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 W BEHREND DR APT 1010
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6921
Mailing Address - Country:US
Mailing Address - Phone:757-784-8541
Mailing Address - Fax:
Practice Address - Street 1:3502 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2707
Practice Address - Country:US
Practice Address - Phone:602-973-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist