Provider Demographics
NPI:1073911483
Name:WEST ROCK COMMUNITY PHARMACY, LLC
Entity Type:Organization
Organization Name:WEST ROCK COMMUNITY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SPECIALIST COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RCPHT
Authorized Official - Phone:727-302-8135
Mailing Address - Street 1:11711 HERMITAGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3718
Mailing Address - Country:US
Mailing Address - Phone:501-221-3100
Mailing Address - Fax:501-907-1053
Practice Address - Street 1:11880 28TH ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1824
Practice Address - Country:US
Practice Address - Phone:727-302-8135
Practice Address - Fax:727-800-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ARAR207573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy