Healthcare Provider Details

I. General information

NPI: 1841390697
Provider Name (Legal Business Name): STUART D. ROCKAFELLOW PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DRIVE SE NEW MEXICO VA HEALTHCARE SYSTEM
ALBUQUERQUE NM
87108-5154
US

IV. Provider business mailing address

716 HUTCHINS AVE
ANN ARBOR MI
48103-4802
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 734-761-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: