Provider Demographics
NPI:1659527513
Name:BROCK, JUSTIN M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:BROCK
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 1:1845 W ORANGE GROVE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1146
Mailing Address - Country:US
Mailing Address - Phone:520-670-0777
Mailing Address - Fax:520-620-9738
Practice Address - Street 1:1845 W ORANGE GROVE RD STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1146
Practice Address - Country:US
Practice Address - Phone:520-670-0777
Practice Address - Fax:520-620-9738
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016703183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist