Provider Demographics
NPI:1255540225
Name:ROCKY MOUNT FAMILY PHARMACY
Entity type:Organization
Organization Name:ROCKY MOUNT FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-627-0536
Mailing Address - Street 1:1165 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1248
Mailing Address - Country:US
Mailing Address - Phone:276-489-5400
Mailing Address - Fax:276-489-5403
Practice Address - Street 1:1165 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1248
Practice Address - Country:US
Practice Address - Phone:276-489-5400
Practice Address - Fax:276-489-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty