Provider Demographics
NPI:1447607320
Name:BROCKMAN, MICHAEL DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 TRYON RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9311
Mailing Address - Country:US
Mailing Address - Phone:919-233-2929
Mailing Address - Fax:
Practice Address - Street 1:5859 TRYON RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9311
Practice Address - Country:US
Practice Address - Phone:919-233-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51084183500000X
VA0202211498183500000X
NC25889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist