Provider Demographics
NPI:1053747907
Name:BOCK, MEGAN JEAN (PHARM D)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:BOCK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JEAN
Other - Last Name:CONNAUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD D
Mailing Address - Street 1:82 NUGENT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 NUGENT ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4816
Practice Address - Country:US
Practice Address - Phone:631-283-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist