Provider Demographics
NPI:1245547827
Name:BROOKS, RON M I (RPH)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:M
Last Name:BROOKS
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:V
Other - Last Name:BROOKS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1514 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1514 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4741
Practice Address - Country:US
Practice Address - Phone:520-836-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6336183500000X
MO29226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist