Provider Demographics
NPI:1457601239
Name:LAROCHE, MARY JO (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:LAROCHE
Suffix:
Gender:F
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:P.O. BOX 622
Mailing Address - Street 2:70239 CENTRAL AVENUE
Mailing Address - City:BARTON
Mailing Address - State:OH
Mailing Address - Zip Code:43905
Mailing Address - Country:US
Mailing Address - Phone:740-359-1386
Mailing Address - Fax:740-699-1294
Practice Address - Street 1:56130 NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912
Practice Address - Country:US
Practice Address - Phone:740-633-3368
Practice Address - Fax:740-633-3438
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221493183500000X
PARP439846183500000X
WVRP0005926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist