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General NPI Number Information
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NPI Number | 1356657019
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Entity Type | Individual
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Provider Name | RHAN ELLIS ROACH RPH
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Gender | Male
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 702 BROWNING LN
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City | BROOKLAWN
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State | NJ
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Zip | 08030-2645
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Country | US
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Telephone | 856-456-7141
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Fax | 856-742-9580
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Provider Business Mailing Address
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Address Line | 908 TWELVE OAKS DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-3536
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Country | US
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Telephone | 856-513-6393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RI17222
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License Number State | NJ
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