Provider Demographics
NPI:1053463737
Name:ROCK, MILISSA ANN (RPH, CDM, CDE)
Entity Type:Individual
Prefix:MS
First Name:MILISSA
Middle Name:ANN
Last Name:ROCK
Suffix:
Gender:F
Credentials:RPH, CDM, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2007
Mailing Address - Country:US
Mailing Address - Phone:860-388-5973
Mailing Address - Fax:860-388-3256
Practice Address - Street 1:148 EASTERN BLVD STE 4
Practice Address - Street 2:WALGREENS DISTRICT 125
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-388-5973
Practice Address - Fax:860-388-3256
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist