Provider Demographics
NPI:1164596706
Name:ROARK'S PHARMACY, INC.
Entity Type:Organization
Organization Name:ROARK'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-569-9000
Mailing Address - Street 1:19118 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6003
Mailing Address - Country:US
Mailing Address - Phone:423-569-9000
Mailing Address - Fax:423-569-2402
Practice Address - Street 1:19118 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6003
Practice Address - Country:US
Practice Address - Phone:423-569-9000
Practice Address - Fax:423-569-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4424165OtherNABP NUMBER