Provider Demographics
NPI:1568052371
Name:ROARK, CHARLES MONTGOMERY (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MONTGOMERY
Last Name:ROARK
Suffix:
Gender:M
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 1:9627 COUNTRYSIDE CENTER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4765
Mailing Address - Country:US
Mailing Address - Phone:865-214-6672
Mailing Address - Fax:865-281-3392
Practice Address - Street 1:9627 COUNTRYSIDE CENTER LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4765
Practice Address - Country:US
Practice Address - Phone:865-214-6672
Practice Address - Fax:865-281-3392
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist