Provider Demographics
NPI:1891517728
Name:DROCK WELLNES LLC
Entity type:Organization
Organization Name:DROCK WELLNES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROCHAEL
Authorized Official - Middle Name:SAVANNAH
Authorized Official - Last Name:ROZHANSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-541-4826
Mailing Address - Street 1:10447 SORRENTO RD
Mailing Address - Street 2:SUITE 100 PMB 102
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507
Mailing Address - Country:US
Mailing Address - Phone:208-541-4826
Mailing Address - Fax:
Practice Address - Street 1:301 N BARCELONA ST STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4834
Practice Address - Country:US
Practice Address - Phone:208-541-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No305R00000XManaged Care OrganizationsPreferred Provider Organization