Provider Demographics
NPI:1982732806
Name:BROOKS, MANDY JEAN (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:JEAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 OAKDALE CIR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0905
Mailing Address - Country:US
Mailing Address - Phone:440-724-4723
Mailing Address - Fax:
Practice Address - Street 1:8585 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-1641
Practice Address - Country:US
Practice Address - Phone:440-826-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06004548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist