Provider Demographics
NPI:1104553775
Name:RAGSDALE, BROOKE NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:RAGSDALE
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 1:1119 BUSBEE RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-9097
Mailing Address - Country:US
Mailing Address - Phone:803-760-5412
Mailing Address - Fax:
Practice Address - Street 1:175 FORUM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7938
Practice Address - Country:US
Practice Address - Phone:803-699-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist