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General NPI Number Information
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NPI Number | 1114371226
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Entity Type | Organization
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Legal Business Name | ROCKWALL PHARMACY LLC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 2504 RIDGE RD SUITE 106
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City | ROCKWALL
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State | TX
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Zip | 75087-2569
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Country | US
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Telephone | 469-769-1160
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Fax | 469-769-1161
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Provider Business Mailing Address
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Address Line | 2504 RIDGE RD SUITE 106
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City | ROCKWALL
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State | TX
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Zip | 75087-2569
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Country | US
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Telephone | 469-769-1160
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Fax | 469-769-1161
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Authorized Official
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Title or Position | MANAGER
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Name | TOMMY JONES
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Credential |
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Telephone | 469-769-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30777
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License Number State | TX
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