Provider Demographics
NPI:1528353000
Name:SHULL, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SHULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12975 SHELBYVILLE RD
Mailing Address - Street 2:T2728
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2405
Mailing Address - Country:US
Mailing Address - Phone:502-992-1238
Mailing Address - Fax:502-992-1248
Practice Address - Street 1:12975 SHELBYVILLE RD
Practice Address - Street 2:T2728
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2405
Practice Address - Country:US
Practice Address - Phone:502-992-1238
Practice Address - Fax:502-992-1248
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist