Provider Demographics
NPI:1346965225
Name:O'CONNELL, BROOKE SUZANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:SUZANNE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4263
Mailing Address - Country:US
Mailing Address - Phone:401-737-2305
Mailing Address - Fax:401-736-0454
Practice Address - Street 1:2400 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-4263
Practice Address - Country:US
Practice Address - Phone:401-737-2305
Practice Address - Fax:401-736-0454
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH4024183500000X
RIRPH04024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist