Provider Demographics
NPI:1235733866
Name:OROCK, NELSON EBOT (PHARMD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:EBOT
Last Name:OROCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6043
Mailing Address - Country:US
Mailing Address - Phone:508-410-2076
Mailing Address - Fax:
Practice Address - Street 1:2102 N. BEACH ST.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4296
Practice Address - Country:US
Practice Address - Phone:817-834-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist