Healthcare Provider Details

I. General information

NPI: 1235011883
Provider Name (Legal Business Name): BROCK'S GAP PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 ELSIE ROAD
HOOVER AL
35244-5702
US

IV. Provider business mailing address

5860 ELSIE ROAD
HOOVER AL
35244-5702
US

V. Phone/Fax

Practice location:
  • Phone: 205-354-6080
  • Fax:
Mailing address:
  • Phone: 205-354-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERT PATRICK DEVEREUX
Title or Position: OWNER
Credential: PHARMD
Phone: 205-354-6080