Provider Demographics
NPI:1548568827
Name:MAY, BROOKE ANDERSON
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANDERSON
Last Name:MAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 COOPER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6415
Mailing Address - Country:US
Mailing Address - Phone:404-723-2022
Mailing Address - Fax:
Practice Address - Street 1:1550 KENNESAW DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4338
Practice Address - Country:US
Practice Address - Phone:770-423-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist