Provider Demographics
NPI:1790966471
Name:ROARK, LORI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:ROARK
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 1:1560 E SHERMAN BLVD
Mailing Address - Street 2:SUITE #145
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1867
Mailing Address - Country:US
Mailing Address - Phone:231-672-6713
Mailing Address - Fax:231-672-6786
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:SUITE #145
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-672-6713
Practice Address - Fax:231-672-6786
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist