Provider Demographics
NPI:1881290328
Name:ROOK, JEREMY LANCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LANCE
Last Name:ROOK
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 1:1016 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4051
Mailing Address - Country:US
Mailing Address - Phone:501-315-5100
Mailing Address - Fax:501-776-1313
Practice Address - Street 1:1016 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4051
Practice Address - Country:US
Practice Address - Phone:501-315-5100
Practice Address - Fax:501-776-1313
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist