Provider Demographics
NPI:1205121381
Name:BROOKS, NATHANIEL DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DAVID
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FREEDOM WAY
Mailing Address - Street 2:K-MART #3815
Mailing Address - City:MIDWAY PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28544
Mailing Address - Country:US
Mailing Address - Phone:910-577-5761
Mailing Address - Fax:
Practice Address - Street 1:175 FREEDOM WAY
Practice Address - Street 2:K-MART #3815
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544
Practice Address - Country:US
Practice Address - Phone:910-577-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist