Provider Demographics
NPI:1972022051
Name:ROCK PHARMACY LLC
Entity Type:Organization
Organization Name:ROCK PHARMACY LLC
Other - Org Name:ROCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:830-357-5052
Mailing Address - Street 1:1201 S MAIN ST STE 121
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2839
Mailing Address - Country:US
Mailing Address - Phone:830-357-5052
Mailing Address - Fax:830-357-5053
Practice Address - Street 1:1201 S MAIN ST STE 121
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2839
Practice Address - Country:US
Practice Address - Phone:830-357-5052
Practice Address - Fax:830-357-5053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279523336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146572Medicaid