Provider Demographics
NPI:1720297492
Name:MARTEN, BROOKE NICOLE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:NICOLE
Last Name:MARTEN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3329
Mailing Address - Country:US
Mailing Address - Phone:314-260-9714
Mailing Address - Fax:636-530-1508
Practice Address - Street 1:749 GODDARD AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1106
Practice Address - Country:US
Practice Address - Phone:636-530-1514
Practice Address - Fax:636-530-1508
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist