Provider Demographics
NPI:1346324019
Name:BROOKS, VICTORIA L (DPH)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LOUIS TITTLE AVE
Mailing Address - Street 2:PO BOX 148
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 N LOUIS TITTLE AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-1618
Practice Address - Country:US
Practice Address - Phone:580-782-2131
Practice Address - Fax:580-782-9280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist