Provider Demographics
NPI:1245210434
Name:ROCK CREEK PHARMACY, INC.
Entity Type:Organization
Organization Name:ROCK CREEK PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-497-8777
Mailing Address - Street 1:6817 WARRIOR RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35023-5602
Mailing Address - Country:US
Mailing Address - Phone:205-497-8777
Mailing Address - Fax:205-497-8797
Practice Address - Street 1:6799 WARRIOR RIVER RD
Practice Address - Street 2:STE.101
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35023-8001
Practice Address - Country:US
Practice Address - Phone:205-497-8777
Practice Address - Fax:205-497-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7866190001OtherMEDICARE DME
AL112692OtherSTATE LICENSE #
Q123610001OtherIMMUNIZATION
AL100003639Medicaid
ALBR9382615OtherDEA #