Provider Demographics
NPI:1811229529
Name:BROOKS, GRADY E (RPH)
Entity Type:Individual
Prefix:MR
First Name:GRADY
Middle Name:E
Last Name:BROOKS
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 1:2903 NE ANDRESEN RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7329
Mailing Address - Country:US
Mailing Address - Phone:360-256-1503
Mailing Address - Fax:360-254-6685
Practice Address - Street 1:2903 NE ANDRESEN RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7329
Practice Address - Country:US
Practice Address - Phone:360-256-1503
Practice Address - Fax:360-254-6685
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00069486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist