Provider Demographics
NPI:1124308796
Name:ROTHROCK, CARA (RPH)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:ROTHROCK
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 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2901
Mailing Address - Country:US
Mailing Address - Phone:815-673-2439
Mailing Address - Fax:815-673-1179
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2901
Practice Address - Country:US
Practice Address - Phone:815-673-2439
Practice Address - Fax:815-673-1179
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist