Basic Information
| Provider Information | |||||||||
| NPI: | 1790856094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARLEY | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4444 W PINE BLVD | ||||||||
| Address2: | APT 113 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631082356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146055553 | ||||||||
| FaxNumber: | 3142518889 | ||||||||
| Practice Location | |||||||||
| Address1: | 12680 OLIVE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142518963 | ||||||||
| FaxNumber: | 3142518889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 2004003296 | MO | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.