Provider Demographics
NPI:1790068997
Name:KING, BROOKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KING
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 1:25575 METCALF RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6319
Mailing Address - Country:US
Mailing Address - Phone:913-575-3095
Mailing Address - Fax:913-236-8929
Practice Address - Street 1:4330 SHAWNEE MISSION PKWY
Practice Address - Street 2:STE 308
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2522
Practice Address - Country:US
Practice Address - Phone:913-236-7271
Practice Address - Fax:913-236-8929
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029238183500000X
KS13493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist