Provider Demographics
NPI:1619009271
Name:REAGAN, CAROL BROOKS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BROOKS
Last Name:REAGAN
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 1:4701 BRYANT IRVIN RD N
Mailing Address - Street 2:LL-STE. 215
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7627
Mailing Address - Country:US
Mailing Address - Phone:817-920-6875
Mailing Address - Fax:817-920-6748
Practice Address - Street 1:4701 BRYANT IRVIN ROAD N
Practice Address - Street 2:LL-STE. 215
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-920-6875
Practice Address - Fax:817-920-6748
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist