Individual
KENNETH WALTER BROOKSHIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 ROSE ST, COVE, OR 97824
(541) 805-8689
Mailing address
PO BOX 205, COVE, OR 97824-0205
(541) 805-8689
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7150
OR
Other
Enumeration date
02/03/2022
Last updated
02/03/2022
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