Provider Demographics
NPI:1598134884
Name:BROOKLERE GROUP LLC
Entity Type:Organization
Organization Name:BROOKLERE GROUP LLC
Other - Org Name:BROOKLERE PHARMACY 104
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKLERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-648-6059
Mailing Address - Street 1:385 BRYAN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-3436
Mailing Address - Country:US
Mailing Address - Phone:205-648-6059
Mailing Address - Fax:205-648-4706
Practice Address - Street 1:385 BRYAN RD
Practice Address - Street 2:STE 200
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-3436
Practice Address - Country:US
Practice Address - Phone:205-648-6059
Practice Address - Fax:205-648-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1030453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154083OtherPK