Provider Demographics
NPI:1306440052
Name:BROOKS, TAMARA (RPH)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-8386
Mailing Address - Country:US
Mailing Address - Phone:972-754-9378
Mailing Address - Fax:
Practice Address - Street 1:702 E TYLER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2112
Practice Address - Country:US
Practice Address - Phone:903-675-7152
Practice Address - Fax:903-675-2209
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist