Provider Demographics
NPI:1043732563
Name:BROOKS, GEORGE DICCON SPENCER (RPH - PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DICCON SPENCER
Last Name:BROOKS
Suffix:
Gender:M
Credentials:RPH - PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2108
Mailing Address - Country:US
Mailing Address - Phone:206-903-8392
Mailing Address - Fax:
Practice Address - Street 1:222 PIKE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2108
Practice Address - Country:US
Practice Address - Phone:206-903-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60735178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist