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General NPI Number Information
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NPI Number | 1457601239
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Entity Type | Individual
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Provider Name | MARY JO LAROCHE R.PH.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 56130 NATIONAL ROAD
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City | BRIDGEPORT
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State | OH
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Zip | 43912
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Country | US
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Telephone | 740-633-3368
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Fax | 740-633-3438
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Provider Business Mailing Address
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Address Line | P.O. BOX 622 70239 CENTRAL AVENUE
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City | BARTON
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State | OH
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Zip | 43905
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Country | US
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Telephone | 740-359-1386
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Fax | 740-699-1294
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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 | 03221493
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP439846
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0005926
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License Number State | WV
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