Active NPI
Bryan Wesley Brooks, PHARM.D.
- Pharmacist
- Rolla, MO
National Provider Identifier
1053695718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2002029007
- Practice address
- 1375 E 10TH St Ste B
Rolla, MO 65401-3591 - Phone
- (573) 364-9616
- Fax
- (573) 341-3986
- NPI assigned
- Sep 29, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2002029007 | MO | Primary |
Addresses
Primary practice location
1375 E 10TH St Ste B
Rolla, MO 65401-3591
Mailing address
19 Burgher Dr
Rolla, MO 65401-3602
Phone (314) 488-8631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002029007 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Rolla, MO
- NPI 1235372749
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595203200000",
"number": "1053695718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 BURGHER DR",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013602",
"telephone_number": "314-488-8631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 E 10TH ST STE B",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013591",
"telephone_number": "573-364-9616",
"fax_number": "573-341-3986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "BRYAN",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-29",
"last_updated": "2020-07-20",
"certification_date": "2020-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2002029007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.