Provider Demographics
NPI:1851636526
Name:BROOKER, DEBORAH STIVENDER (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:STIVENDER
Last Name:BROOKER
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 1:1441 APPLING DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4688
Mailing Address - Country:US
Mailing Address - Phone:843-814-4705
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3135
Practice Address - Country:US
Practice Address - Phone:843-856-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist