Provider Demographics
NPI:1083038574
Name:OAKES, BROCK (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:OAKES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SHREVEPORT BARKSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2404
Mailing Address - Country:US
Mailing Address - Phone:318-861-9212
Mailing Address - Fax:318-861-9236
Practice Address - Street 1:1125 SHREVEPORT BARKSDALE HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2404
Practice Address - Country:US
Practice Address - Phone:318-861-9212
Practice Address - Fax:318-861-9236
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist