Provider Demographics
NPI:1811620081
Name:TRABERT, BROOKE RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
Last Name:TRABERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:RENEE
Other - Last Name:LAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:234 RIVER RUN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-6500
Practice Address - Country:US
Practice Address - Phone:574-269-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029269A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist