Provider Demographics
NPI:1114651585
Name:BROCK, HANNAH SMITH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:SMITH
Last Name:BROCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-0005
Mailing Address - Country:US
Mailing Address - Phone:919-936-3151
Mailing Address - Fax:
Practice Address - Street 1:102 E EDWARDS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-7279
Practice Address - Country:US
Practice Address - Phone:919-936-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist