Provider Demographics
NPI:1750985487
Name:MYERS, BROOKE (PHARMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 LENOX BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:GA
Mailing Address - Zip Code:31637-5509
Mailing Address - Country:US
Mailing Address - Phone:229-206-0406
Mailing Address - Fax:
Practice Address - Street 1:111 8TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4099
Practice Address - Country:US
Practice Address - Phone:229-382-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist