Provider Demographics
NPI:1427237288
Name:ROCHE, BRUCE E (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:ROCHE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2247
Mailing Address - Country:US
Mailing Address - Phone:716-662-0464
Mailing Address - Fax:
Practice Address - Street 1:10401 BENNETT RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1402
Practice Address - Country:US
Practice Address - Phone:716-679-3160
Practice Address - Fax:716-679-3160
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist