Provider Demographics
NPI:1902244866
Name:MENON, BROOKE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:MENON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8731 SYCAMORE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9118
Mailing Address - Country:US
Mailing Address - Phone:952-484-1694
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:RL PHARMACY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist