Provider Demographics
NPI:1326338344
Name:ROCERETA, EDWARD T (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:ROCERETA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-2723
Mailing Address - Country:US
Mailing Address - Phone:404-558-1499
Mailing Address - Fax:
Practice Address - Street 1:1105 WARM SPRINGS HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1167
Practice Address - Country:US
Practice Address - Phone:706-846-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist