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General NPI Number Information
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NPI Number | 1124394283
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Entity Type | Organization
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Legal Business Name | ROCK PHARMACY LLC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST SUITE 121
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City | BOERNE
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State | TX
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Zip | 78006-2833
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Country | US
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Telephone | 830-357-5052
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Fax | 830-357-5053
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Provider Business Mailing Address
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Address Line | PO BOX 2422
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City | BOERNE
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State | TX
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Zip | 78006-1400
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Country | US
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Telephone | 830-357-5052
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Fax | 830-357-5053
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PIC
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Name | PETER ORAEKWE
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Credential | PHARM D
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Telephone | 830-357-5052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27952
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License Number State | TX
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