Provider Demographics
NPI:1578106589
Name:BURGESS, BROOKE RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
Last Name:BURGESS
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 1:9840 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3201
Mailing Address - Country:US
Mailing Address - Phone:561-509-2142
Mailing Address - Fax:561-509-2143
Practice Address - Street 1:9840 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3201
Practice Address - Country:US
Practice Address - Phone:561-509-2142
Practice Address - Fax:561-509-2143
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist