Provider Demographics
NPI:1730199282
Name:BROOKLERE GROUP LLC
Entity type:Organization
Organization Name:BROOKLERE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROOKLERE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-648-6059
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:385 BRYAN RD STE 200
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-0249
Mailing Address - Country:US
Mailing Address - Phone:205-648-6059
Mailing Address - Fax:205-648-4706
Practice Address - Street 1:385 BRYAN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148
Practice Address - Country:US
Practice Address - Phone:205-648-6059
Practice Address - Fax:205-648-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1030453336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002021Medicaid
AL100002021Medicaid