MEDICARE: EDWARD T ROCERETA R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH011361	GA

General Provider Information

NPI Number	:	1326338344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD T ROCERETA R.PH

Provider Business Mailing Address
First Line	:	7227 ROOSEVELT HWY
Second Line	:
City	:	WARM SPRINGS
State	:	GA
Zip	:	31830-2723
Country	:	US
Telephone Number	:	404-558-1499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 WARM SPRINGS HWY
Second Line	:
City	:	MANCHESTER
State	:	GA
Zip	:	31816-1167
Country	:	US
Telephone Number	:	706-846-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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Directions to “ EDWARD T ROCERETA R.PH” Practice Location

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