Provider Demographics
NPI:1073927174
Name:BROCK, TERIONE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERIONE
Middle Name:M
Last Name:BROCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 SAINT CLAUDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ARABI
Mailing Address - State:LA
Mailing Address - Zip Code:70032-1247
Mailing Address - Country:US
Mailing Address - Phone:504-324-9229
Mailing Address - Fax:504-302-9229
Practice Address - Street 1:6721 ST. CLAUDE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032
Practice Address - Country:US
Practice Address - Phone:504-324-9229
Practice Address - Fax:504-302-9228
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17211183500000X
MS13820183500000X
LA020712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist