Provider Demographics
NPI:1235011883
Name:BROCK'S GAP PHARMACY, INC.
Entity type:Organization
Organization Name:BROCK'S GAP PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DEVEREUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-354-6080
Mailing Address - Street 1:5860 ELSIE ROAD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5702
Mailing Address - Country:US
Mailing Address - Phone:205-354-6080
Mailing Address - Fax:
Practice Address - Street 1:5860 ELSIE ROAD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-5702
Practice Address - Country:US
Practice Address - Phone:205-354-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy