Healthcare Provider Details

I. General information

NPI: 1508398991
Provider Name (Legal Business Name): ROCKFISH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 FLAGSTONE LANE
RAEFORD NC
28376
US

IV. Provider business mailing address

221 FLAGSTONE LANE
RAEFORD NC
28376
US

V. Phone/Fax

Practice location:
  • Phone: 910-850-2111
  • Fax:
Mailing address:
  • Phone: 910-565-1115
  • Fax: 910-565-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ALLEN
Title or Position: OWNER
Credential:
Phone: 910-565-1115