Provider Demographics
NPI:1831469675
Name:ROTHROCK, STACIE ANN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:STACIE
Middle Name:ANN
Last Name:ROTHROCK
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 1:12 ST PAUL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1035
Mailing Address - Country:US
Mailing Address - Phone:717-217-6790
Mailing Address - Fax:
Practice Address - Street 1:12 ST PAUL DR STE 105
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-217-6790
Practice Address - Fax:717-217-6925
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP447462OtherSTATE LICENSE