Basic Information
| Provider Information | |||||||||
| NPI: | 1790049138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROARK | ||||||||
| FirstName: | ANGIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 OAK HILL DR | ||||||||
| Address2: | APARTMENT 203-E | ||||||||
| City: | WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286978795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287198816 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1920 W PARK DR | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368388988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22571 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.