Provider Demographics
NPI:1356851448
Name:TABONE, BROOKE NIELSEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:NIELSEN
Last Name:TABONE
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 1:450 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2436
Mailing Address - Country:US
Mailing Address - Phone:435-650-3848
Mailing Address - Fax:
Practice Address - Street 1:317 E 100 N STE 4
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2504
Practice Address - Country:US
Practice Address - Phone:435-637-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333267-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist