Provider Demographics
NPI:1255009171
Name:BROOKS, OCTAVIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
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 1:8525 W WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3625
Mailing Address - Country:US
Mailing Address - Phone:702-505-4955
Mailing Address - Fax:702-505-4956
Practice Address - Street 1:8525 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3625
Practice Address - Country:US
Practice Address - Phone:702-505-4955
Practice Address - Fax:702-505-4956
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV209501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist