Provider Demographics
NPI:1417001215
Name:ROCWKELL, JARRETT CAINE II
Entity Type:Individual
Prefix:
First Name:JARRETT
Middle Name:CAINE
Last Name:ROCWKELL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 SADDLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2384
Mailing Address - Country:US
Mailing Address - Phone:804-639-1535
Mailing Address - Fax:
Practice Address - Street 1:1950 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2729
Practice Address - Country:US
Practice Address - Phone:804-733-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist