Healthcare Provider Details

I. General information

NPI: 1255888236
Provider Name (Legal Business Name): JULIANNA L. ROCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4586 TIMBER RIDGE DR SUITE 200
DOUGLASVILLE GA
30135-7517
US

IV. Provider business mailing address

4586 TIMBER RIDGE DRIVE SUITE 200
DOUGLASVILLE GA
30135-7514
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-0457
  • Fax: 770-942-7699
Mailing address:
  • Phone: 770-942-0457
  • Fax: 770-942-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41441
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH024095
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: