Provider Demographics
NPI:1720007693
Name:BROUKER, MARK EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:BROUKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US NAVAL HOSPITAL ROTA SPAIN
Mailing Address - Street 2:PSC 819 BOX 18-002
Mailing Address - City:FPO
Mailing Address - State:ROTA
Mailing Address - Zip Code:AE
Mailing Address - Country:ES
Mailing Address - Phone:011-349-5682
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL ROTA SPAIN
Practice Address - Street 2:PSC 819 BOX 18-002
Practice Address - City:FPO
Practice Address - State:ROTA
Practice Address - Zip Code:AE
Practice Address - Country:ES
Practice Address - Phone:011-349-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA25105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist