Provider Demographics
NPI:1205344397
Name:ROCKETT, DANIEL REID (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:REID
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 BENJAMIN RD
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:LA
Mailing Address - Zip Code:71467-3068
Mailing Address - Country:US
Mailing Address - Phone:318-355-7875
Mailing Address - Fax:
Practice Address - Street 1:184 BENJAMIN RD
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467-3068
Practice Address - Country:US
Practice Address - Phone:318-355-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist