Provider Demographics
NPI:1962285957
Name:ACKERMAN, BROOKE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:ACKERMAN
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 1:16438 N HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-6888
Mailing Address - Country:US
Mailing Address - Phone:208-687-0731
Mailing Address - Fax:
Practice Address - Street 1:8699 W SEED AVE
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-3312
Practice Address - Country:US
Practice Address - Phone:402-989-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist