Provider Demographics
NPI:1962003681
Name:BROOKS, EVELYN J
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:J
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3219
Mailing Address - Country:US
Mailing Address - Phone:703-280-3350
Mailing Address - Fax:
Practice Address - Street 1:7235 ARLINGTON BLVD # 7235
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3219
Practice Address - Country:US
Practice Address - Phone:703-280-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0202010912183500000X
VA0202010912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist