Provider Demographics
NPI:1225707516
Name:CHAVIS, BROOKE LEANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEANNE
Last Name:CHAVIS
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-0056
Mailing Address - Country:US
Mailing Address - Phone:910-740-3820
Mailing Address - Fax:
Practice Address - Street 1:503 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7989
Practice Address - Country:US
Practice Address - Phone:910-521-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist