Healthcare Provider Details

I. General information

NPI: 1619568268
Provider Name (Legal Business Name): JESSICA DEROCHE PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E FRANKLIN BLVD
GASTONIA NC
28056-9451
US

IV. Provider business mailing address

3000 E FRANKLIN BLVD
GASTONIA NC
28056-9451
US

V. Phone/Fax

Practice location:
  • Phone: 678-458-4760
  • Fax:
Mailing address:
  • Phone: 678-458-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029991
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: