Provider Demographics
NPI:1962795146
Name:ROCHE, SHARI ANN (SHARI ROCHE)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:ROCHE
Suffix:
Gender:F
Credentials:SHARI ROCHE
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:ROCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHARI ROCHE
Mailing Address - Street 1:6369 MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-840-2829
Mailing Address - Fax:
Practice Address - Street 1:8085 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1203
Practice Address - Country:US
Practice Address - Phone:440-717-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist