Basic Information
| Provider Information | |||||||||
| NPI: | 1194162164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODE | ||||||||
| FirstName: | BROOKS | ||||||||
| MiddleName: | PAYNE | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 COWLES CLINC WAY | ||||||||
| Address2: | SUITE M-200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306425285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064540159 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 COWLES CLINC WAY | ||||||||
| Address2: | SUITE M-200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306425285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064540159 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | RPH013551 | GA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.