Provider Demographics
NPI:1912211608
Name:BROOKS, SAMANTHA R (BS, PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 3865
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126
Mailing Address - Country:US
Mailing Address - Phone:004-965-6561
Mailing Address - Fax:004-965-3183
Practice Address - Street 1:UNIT 3865
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126-0000
Practice Address - Country:US
Practice Address - Phone:004-965-6561
Practice Address - Fax:004-965-3183
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02812400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist