Provider Demographics
NPI:1336744374
Name:BROOKS, MARK AARON (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:AARON
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 1:3780 MYSTIC VALLEY PKWY APT 111
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6919
Mailing Address - Country:US
Mailing Address - Phone:978-882-3836
Mailing Address - Fax:
Practice Address - Street 1:199 GREAT RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2713
Practice Address - Country:US
Practice Address - Phone:781-275-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist