Provider Demographics
NPI:1770805665
Name:BROOK, JEFFREY J (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:BROOK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2113
Mailing Address - Country:US
Mailing Address - Phone:716-373-2964
Mailing Address - Fax:
Practice Address - Street 1:111 E GREEN ST
Practice Address - Street 2:C/O DAN HORN PHCY
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3641
Practice Address - Country:US
Practice Address - Phone:716-376-6337
Practice Address - Fax:716-372-2634
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034452-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist