Provider Demographics
NPI:1952324329
Name:ROCKWELL, RAEFORD DEWITT (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAEFORD
Middle Name:DEWITT
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NIBLICK LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2635
Mailing Address - Country:US
Mailing Address - Phone:540-248-3727
Mailing Address - Fax:540-234-9157
Practice Address - Street 1:1153 KEEZLETOWN RD
Practice Address - Street 2:
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-0160
Practice Address - Country:US
Practice Address - Phone:540-234-9940
Practice Address - Fax:540-234-9157
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist