Provider Demographics
NPI:1942977376
Name:ROCK, AMBER (RPH)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 JACOBS RUN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-8417
Mailing Address - Country:US
Mailing Address - Phone:304-476-9916
Mailing Address - Fax:
Practice Address - Street 1:80 SKYLINE PLAZA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-3902
Practice Address - Country:US
Practice Address - Phone:304-472-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist