Healthcare Provider Details

I. General information

NPI: 1063016244
Provider Name (Legal Business Name): KATHLEEN ALYSA ROCHE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 IMMOKALEE RD
NAPLES FL
34110-1445
US

IV. Provider business mailing address

10212 GATOR BAY CT
NAPLES FL
34120-4599
US

V. Phone/Fax

Practice location:
  • Phone: 239-597-1600
  • Fax:
Mailing address:
  • Phone: 978-691-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH21384
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1554
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH68601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: