Provider Demographics
NPI:1952310161
Name:HART, BROOKS W (RPH)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:W
Last Name:HART
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 1:613 E LAMAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3757
Mailing Address - Country:US
Mailing Address - Phone:229-928-9010
Mailing Address - Fax:229-928-4477
Practice Address - Street 1:613 E LAMAR ST STE B
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3757
Practice Address - Country:US
Practice Address - Phone:229-928-9010
Practice Address - Fax:229-928-4477
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist