Provider Demographics
NPI:1710716055
Name:GUERNSEY, BROOKE ANN
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ANN
Last Name:GUERNSEY
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:MC GRAW
Mailing Address - State:NY
Mailing Address - Zip Code:13101-0312
Mailing Address - Country:US
Mailing Address - Phone:607-283-3913
Mailing Address - Fax:
Practice Address - Street 1:650 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1146
Practice Address - Country:US
Practice Address - Phone:607-770-7173
Practice Address - Fax:607-770-8591
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty