Provider Demographics
NPI:1861502965
Name:ROARK, DENISE TRENT (PHARM D)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:TRENT
Last Name:ROARK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 BELLSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-443-9238
Mailing Address - Fax:479-521-9111
Practice Address - Street 1:100 W DICKSON STREET
Practice Address - Street 2:COLLIER DRUG STORE
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-442-6261
Practice Address - Fax:479-587-6889
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist