Provider Demographics
NPI:1972782308
Name:ROCHE, DIANE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:PHARMD
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 1:9062 ERIE RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-8824
Practice Address - Country:US
Practice Address - Phone:716-549-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist