Provider Demographics
NPI:1518240993
Name:ROARK, KRISTA (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E DOVER ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3048
Mailing Address - Country:US
Mailing Address - Phone:410-822-2666
Mailing Address - Fax:410-819-8830
Practice Address - Street 1:30 E DOVER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3048
Practice Address - Country:US
Practice Address - Phone:410-822-2666
Practice Address - Fax:410-819-8830
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20338OtherSTATE OF MARYLAND BOARD OF PHARMACY