MEDICARE: ROCK 3

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH24391	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123396	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194055244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK 3

Provider Business Mailing Address
First Line	:	PO BOX 410917
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32941-0917
Country	:	US
Telephone Number	:	850-292-1917
Fax Number	:	321-259-3330

Provider Business Practice Location Address
First Line	:	2448 US HIGHWAY 1
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754-3854
Country	:	US
Telephone Number	:	321-567-4919
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	JOHN ONI
Credential	:
Telephone Number	:	850-292-1917

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	04/22/2016

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Directions to “ROCK 3 ” Practice Location

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