MEDICARE: ROTHROCK DRUG COMPANY INC

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	AR00793	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1992798	OTHER		PK

General Provider Information

NPI Number	:	1295732717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROTHROCK DRUG COMPANY INC

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	BLYTHEVILLE
State	:	AR
Zip	:	72316-0424
Country	:	US
Telephone Number	:	870-763-4451
Fax Number	:	870-838-1821

Provider Business Practice Location Address
First Line	:	700 N 6TH ST
Second Line	:
City	:	BLYTHEVILLE
State	:	AR
Zip	:	72315-2412
Country	:	US
Telephone Number	:	870-763-4451
Fax Number	:	870-838-1821

Authorized Official
Title or Position	:	PHRM OWNER
Name	:	KATHLEEN ROTHROCK
Credential	:	PD
Telephone Number	:	870-763-4451

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/03/2015

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Directions to “ROTHROCK DRUG COMPANY INC ” Practice Location

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