Provider Demographics
NPI:1215517842
Name:JOHNSON, BROOKE (RPH,PHARMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:JOHNSON
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 1:3224 POTTERS HOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-3018
Mailing Address - Country:US
Mailing Address - Phone:817-899-6542
Mailing Address - Fax:
Practice Address - Street 1:5659 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6225
Practice Address - Country:US
Practice Address - Phone:214-252-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist