Provider Demographics
NPI:1831379593
Name:JOCK, CATHERINE ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANNE
Last Name:JOCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2305
Mailing Address - Country:US
Mailing Address - Phone:315-788-0309
Mailing Address - Fax:315-788-1702
Practice Address - Street 1:1 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9503
Practice Address - Country:US
Practice Address - Phone:315-493-3606
Practice Address - Fax:315-493-1748
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist