Individual
ROBERT BLAKE BROCKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22218 N 1750 EAST RD, DANVILLE, IL 61834-7456
(217) 260-0688
Mailing address
22218 N 1750 EAST RD, DANVILLE, IL 61834-7456
(217) 260-0688
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
087172
NY
183700000X
Pharmacy Technician
Primary
049.160038
IL
Other
Enumeration date
06/12/2011
Last updated
06/12/2011
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