Provider Demographics
NPI:1295017390
Name:BROOKS, STEVEN (R PH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OBERLIN CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1816
Mailing Address - Country:US
Mailing Address - Phone:908-668-8348
Mailing Address - Fax:
Practice Address - Street 1:110 MOUNTAIN BLVD EXT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5633
Practice Address - Country:US
Practice Address - Phone:732-907-6745
Practice Address - Fax:732-907-6747
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02594700183500000X
NY032161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist