Provider Demographics
NPI:1700133352
Name:LE, BROOKE H (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:H
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 MARLENE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-0866
Mailing Address - Country:US
Mailing Address - Phone:504-905-3196
Mailing Address - Fax:504-301-0773
Practice Address - Street 1:866 MARLENE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7642
Practice Address - Country:US
Practice Address - Phone:504-905-3196
Practice Address - Fax:504-301-0773
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist