Provider Demographics
NPI:1629682836
Name:BROOKS, GREGORY DAVID SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DAVID
Last Name:BROOKS
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14001 HWY 29
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:888-402-2231
Mailing Address - Fax:888-905-0581
Practice Address - Street 1:14001 HWY 29
Practice Address - Street 2:SUITE 202A
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642
Practice Address - Country:US
Practice Address - Phone:888-402-2231
Practice Address - Fax:888-905-0581
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX32069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist