Provider Demographics
NPI:1497058986
Name:SHROCK, CHARLES FRANCIS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FRANCIS
Last Name:SHROCK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1920
Mailing Address - Country:US
Mailing Address - Phone:804-240-5286
Mailing Address - Fax:
Practice Address - Street 1:80 WESTLAKE
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24121
Practice Address - Country:US
Practice Address - Phone:804-240-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45961835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric