Individual
BROOK SMITH DESRIVIERES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
611 N SAINT JOSEPH AVE, MARSHFIELD, WI 54449-1832
(715) 387-9916
(715) 387-7650
Mailing address
1113 S LOCUST AVE, MARSHFIELD, WI 54449-4033
(715) 387-9916
(715) 387-7650
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
03-01-27524
OH
183500000X
Pharmacist
Primary
5302034164
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-1-27524
PHARMACIST LICENSE
OH
01
—
15350-40
STATE OF WISCONSIN
WI
01
—
5302034164
PHARMACISTS LICENSE
MI
Enumeration date
08/23/2006
Last updated
06/05/2014
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