Provider Demographics
NPI:1467042101
Name:ROCHA, MARICE AMBROSIO (RPH PHARMD)
Entity Type:Individual
Prefix:
First Name:MARICE
Middle Name:AMBROSIO
Last Name:ROCHA
Suffix:
Gender:F
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1626
Mailing Address - Country:US
Mailing Address - Phone:508-308-8174
Mailing Address - Fax:508-683-0270
Practice Address - Street 1:100 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2627
Practice Address - Country:US
Practice Address - Phone:508-308-8174
Practice Address - Fax:508-683-0270
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist