Provider Demographics
NPI:1396971867
Name:ROARK, TINA L (RPH)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:L
Last Name:ROARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:L
Other - Last Name:ROARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4101 TATES CREEK SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517
Mailing Address - Country:US
Mailing Address - Phone:859-273-0222
Mailing Address - Fax:859-971-3452
Practice Address - Street 1:652 POPLAR SPRINGS LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6082
Practice Address - Country:US
Practice Address - Phone:859-273-0222
Practice Address - Fax:859-971-3452
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist