David Jacob Roark

Primary specialty

PharmacistTaxonomy code 183500000X

License

023778 Issued in LA

Practice address

104 W Line Ave
Ruston, LA 71270-5044

Phone

(318) 255-7363

Fax

(318) 255-7365

NPI assigned

Aug 14, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • El Dorado, AR
  • NPI 1568477826
  NPD
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1679184352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2135 N WEST AVE",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717303351",
            "telephone_number": "870-862-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W LINE AVE",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705044",
            "telephone_number": "318-255-7363",
            "fax_number": "318-255-7365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2135 N West Ave",
            "address_purpose": "LOCATION",
            "city": "El Dorado",
            "state": "AR",
            "postal_code": "717303351",
            "country_code": "US",
            "telephone_number": "870-862-5458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROARK",
        "first_name": "DAVID",
        "middle_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-14",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "023778",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PN06516",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wynne Dee Rinicker, APRN/MASTER FNP
• Rise of Ruston LLC
• Rising Kare Counseling LLC
• RL Investment Group, LLC
• Kimberly A Roach, D.P.T.
• Robert B Kirton, DPM Inc
• Robert C. Rendina, D.C., Apc
• Jesse Henton Roberts Jr., DDS
• Jesse Henton Roberts III, DDS
• Annie Robertson, M.A., CCC-SLP

• Pharmacist in Ruston, LA
• Providers in Ruston, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.