Provider Demographics
NPI:1124098611
Name:ROCK, MARK E (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:ROCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:13317 123RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8372
Mailing Address - Country:US
Mailing Address - Phone:360-659-7488
Mailing Address - Fax:360-530-7795
Practice Address - Street 1:3711 88TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7214
Practice Address - Country:US
Practice Address - Phone:360-530-7761
Practice Address - Fax:360-530-7795
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist