Healthcare Provider Details

I. General information

NPI: 1356657019
Provider Name (Legal Business Name): RHAN ELLIS ROACH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BROWNING LN
BROOKLAWN NJ
08030-2645
US

IV. Provider business mailing address

908 TWELVE OAKS DR
WILLIAMSTOWN NJ
08094-3536
US

V. Phone/Fax

Practice location:
  • Phone: 856-456-7141
  • Fax: 856-742-9580
Mailing address:
  • Phone: 856-513-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI17222
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: