Provider Demographics
NPI:1992035182
Name:MEDROCK PHARMACY, LLC
Entity Type:Organization
Organization Name:MEDROCK PHARMACY, LLC
Other - Org Name:MEDROCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL & VP
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:727-512-1969
Mailing Address - Street 1:3209 TAMPA ROAD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3424
Mailing Address - Country:US
Mailing Address - Phone:727-240-1341
Mailing Address - Fax:727-240-1343
Practice Address - Street 1:3209 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3424
Practice Address - Country:US
Practice Address - Phone:727-240-1341
Practice Address - Fax:727-240-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH244023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy