Provider Demographics
NPI:1528481066
Name:FROCK, LANETTE (RPH)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:
Last Name:FROCK
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 1:101 LAFFERTY STE A
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-3685
Mailing Address - Country:US
Mailing Address - Phone:254-605-1150
Mailing Address - Fax:254-605-1155
Practice Address - Street 1:101 LAFFERTY STE A
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-3685
Practice Address - Country:US
Practice Address - Phone:254-605-1150
Practice Address - Fax:254-605-1155
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26718183500000X
CO14280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist