=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578017828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA BOCK RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2016
-----------------------------------------------------
Last Update Date | 08/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 TURNER ST
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28315-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-695-1255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5013 LEGENDS DR
-----------------------------------------------------
City | SOUTHERN PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28387-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-446-1821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26209
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------