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General NPI Number Information
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NPI Number | 1407363815
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Entity Type | Individual
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Provider Name | BRIAN DOUGLAS ROARK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 59 HIGHWAY 15 N
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City | JACKSON
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State | KY
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Zip | 41339-9631
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Country | US
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Telephone | 606-666-2883
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Fax |
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Provider Business Mailing Address
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Address Line | 316 HEMLOCK LN
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City | BLACKEY
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State | KY
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Zip | 41804-8741
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Country | US
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Telephone | 502-381-8152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 019657
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License Number State | KY
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