Provider Demographics
NPI:1154865822
Name:BROOK, ANNA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BROOK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 E 18TH ST
Mailing Address - Street 2:APT 5E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2147
Mailing Address - Country:US
Mailing Address - Phone:917-974-8312
Mailing Address - Fax:718-366-6901
Practice Address - Street 1:5456 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3453
Practice Address - Country:US
Practice Address - Phone:718-366-6900
Practice Address - Fax:718-366-6901
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist