Provider Demographics
NPI:1821295619
Name:BLISS, BROOKE TOKAYE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:TOKAYE
Last Name:BLISS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-2041
Mailing Address - Country:US
Mailing Address - Phone:810-720-2778
Mailing Address - Fax:810-720-2757
Practice Address - Street 1:2050 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4161
Practice Address - Country:US
Practice Address - Phone:810-720-2778
Practice Address - Fax:810-720-2757
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist