Provider Demographics
NPI:1992189492
Name:ROACH, CATHERINE S (PHARMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:ROACH
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 1:5179 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-9516
Mailing Address - Country:US
Mailing Address - Phone:910-483-9482
Mailing Address - Fax:
Practice Address - Street 1:5179 CLINTON RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-9516
Practice Address - Country:US
Practice Address - Phone:910-483-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist