Provider Demographics
NPI:1619283207
Name:BROOKBANK, DANIEL ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANTHONY
Last Name:BROOKBANK
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 1:524 WILLIAMSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1800
Mailing Address - Country:US
Mailing Address - Phone:856-262-9564
Mailing Address - Fax:856-262-0299
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1800
Practice Address - Country:US
Practice Address - Phone:858-262-9564
Practice Address - Fax:856-262-0299
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02857500183500000X
FLPS 46113183500000X
NY054440-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist