Provider Demographics
NPI:1740546548
Name:LA ROCK, DAVID WILLIAM JR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:LA ROCK
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4849
Mailing Address - Country:US
Mailing Address - Phone:414-476-0785
Mailing Address - Fax:
Practice Address - Street 1:6900 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4849
Practice Address - Country:US
Practice Address - Phone:414-476-0785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9570-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist