Provider Demographics
NPI:1184046641
Name:BROOKS, CORINNE EDWARDS (RPH)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:EDWARDS
Last Name:BROOKS
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 1:109 S VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5026
Mailing Address - Country:US
Mailing Address - Phone:336-623-9026
Mailing Address - Fax:336-623-9052
Practice Address - Street 1:109 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5026
Practice Address - Country:US
Practice Address - Phone:336-623-9026
Practice Address - Fax:336-623-9052
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist