Provider Demographics
NPI:1114537057
Name:ROCHE, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
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 1:2100 SOUTH BLVD APT 4208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6725
Mailing Address - Country:US
Mailing Address - Phone:717-476-0218
Mailing Address - Fax:
Practice Address - Street 1:16625 LANCASTER HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2038
Practice Address - Country:US
Practice Address - Phone:717-476-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist