Provider Demographics
NPI:1467052894
Name:BROOKS, LESLIE BROOKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BROOKE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4748
Mailing Address - Country:US
Mailing Address - Phone:662-350-6920
Mailing Address - Fax:662-350-6919
Practice Address - Street 1:316 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4748
Practice Address - Country:US
Practice Address - Phone:662-350-6920
Practice Address - Fax:662-350-6919
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-12625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist