Provider Demographics
NPI:1487008702
Name:SHOOK, BRIAN ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:SHOOK
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 1:1508 GALLATIN PIKE S
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5353
Mailing Address - Country:US
Mailing Address - Phone:615-865-6095
Mailing Address - Fax:615-868-5116
Practice Address - Street 1:1508 GALLATIN PIKE S
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5353
Practice Address - Country:US
Practice Address - Phone:615-865-6095
Practice Address - Fax:615-868-5116
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist