Provider Demographics
NPI:1063526390
Name:BULLOCK, JOHN SAMUEL (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SAMUEL
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FARM MARKET ROAD 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-897-1987
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:1000 FARM MARKET ROAD 300
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6235
Practice Address - Country:US
Practice Address - Phone:806-897-1987
Practice Address - Fax:806-894-3378
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist