Provider Demographics
NPI:1558421164
Name:BROOKS, GREGORY S (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:S
Last Name:BROOKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2204
Mailing Address - Country:US
Mailing Address - Phone:410-262-3108
Mailing Address - Fax:
Practice Address - Street 1:7172 COLUMBIA GATEWAY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2990
Practice Address - Country:US
Practice Address - Phone:188-866-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11735183500000X, 1835N0905X
AL184031835X0200X
MI53020435761835X0200X
ARPD124441835X0200X
WVRP00086421835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear
No1835X0200XPharmacy Service ProvidersPharmacistOncology