Provider Demographics
NPI:1790117364
Name:BROOKS, ETHAN CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:CHARLES
Last Name:BROOKS
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 1:3500 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8819
Mailing Address - Country:US
Mailing Address - Phone:919-463-7990
Mailing Address - Fax:919-463-7992
Practice Address - Street 1:3500 DAVIS DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8819
Practice Address - Country:US
Practice Address - Phone:919-463-7990
Practice Address - Fax:919-463-7992
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist