Provider Demographics
NPI:1255701355
Name:WITTROCK, BROOKE LAURA (PHARM D)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LAURA
Last Name:WITTROCK
Suffix:
Gender:
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 JERDEE LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-7253
Mailing Address - Country:US
Mailing Address - Phone:712-261-1983
Mailing Address - Fax:
Practice Address - Street 1:2200 17TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1007
Practice Address - Country:US
Practice Address - Phone:712-336-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist