MEDICARE: MATTHEW DAVID ROESCH RPH

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	28RI03668000	NJ

General Provider Information

NPI Number	:	1932727898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID ROESCH RPH

Provider Business Mailing Address
First Line	:	114 W SHORE RD
Second Line	:
City	:	DENVILLE
State	:	NJ
Zip	:	07834-1573
Country	:	US
Telephone Number	:	717-870-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 SPRING ST STE 105
Second Line	:
City	:	NEW PROVIDENCE
State	:	NJ
Zip	:	07974-1143
Country	:	US
Telephone Number	:	201-380-7700
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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