Provider Demographics
NPI:1104348135
Name:MCKEE, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MCKEE
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 1:1500 E SUNSHINE ST STE 148
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1203
Mailing Address - Country:US
Mailing Address - Phone:417-520-0607
Mailing Address - Fax:417-520-0608
Practice Address - Street 1:1500 E SUNSHINE ST STE 148
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1203
Practice Address - Country:US
Practice Address - Phone:417-520-0607
Practice Address - Fax:417-520-0608
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist