Provider Demographics
NPI:1053922526
Name:CHITWOOD, BROOKLYNE PAIGE (PHARMD RPH)
Entity type:Individual
Prefix:MS
First Name:BROOKLYNE
Middle Name:PAIGE
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 TRACERY OAKS DR APT 2211
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-8306
Mailing Address - Country:US
Mailing Address - Phone:606-310-8770
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3066
Practice Address - Country:US
Practice Address - Phone:859-272-2575
Practice Address - Fax:859-272-0813
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0215121835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty