Provider Demographics
NPI:1790558898
Name:BROCK, IZABELLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IZABELLA
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 N YANTLEY ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1844
Mailing Address - Country:US
Mailing Address - Phone:915-471-6949
Mailing Address - Fax:
Practice Address - Street 1:568 US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BYERS
Practice Address - State:CO
Practice Address - Zip Code:80103-9700
Practice Address - Country:US
Practice Address - Phone:303-822-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist