Provider Demographics
NPI:1275065286
Name:LETCHWORTH, BROOKE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:LETCHWORTH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2012
Mailing Address - Country:US
Mailing Address - Phone:252-823-6081
Mailing Address - Fax:
Practice Address - Street 1:112 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2012
Practice Address - Country:US
Practice Address - Phone:252-823-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist