Provider Demographics
NPI:1770675779
Name:BROOKER, HOWARD GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:GEORGE
Last Name:BROOKER
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 1:2233 MENLO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4722
Mailing Address - Country:US
Mailing Address - Phone:215-886-4364
Mailing Address - Fax:215-572-0555
Practice Address - Street 1:241 N KESWICK AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4803
Practice Address - Country:US
Practice Address - Phone:215-572-1118
Practice Address - Fax:215-572-0555
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040627L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3985213OtherNCPDP