Provider Demographics
NPI:1629523907
Name:LAROUCHE, MARIE CLAIRE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CLAIRE
Last Name:LAROUCHE
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 1:78A ALLENSON AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7868
Mailing Address - Country:US
Mailing Address - Phone:508-838-7237
Mailing Address - Fax:
Practice Address - Street 1:78A ALLENSON AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7868
Practice Address - Country:US
Practice Address - Phone:508-838-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH236785OtherMASSACHUSETTS BOARD OF PHARMACY