Healthcare Provider Details
I. General information
NPI: 1114184553
Provider Name (Legal Business Name): SABRINA JOY BROCK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/22/2008
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US
IV. Provider business mailing address
10802 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4377
US
V. Phone/Fax
- Phone: 501-257-1000
- Fax:
- Phone: 501-257-5188
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 183500000X |
| Taxonomy | Pharmacist |
| License Number | PD-09904 |
| License Number State | AR |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: