Provider Demographics
NPI:1639771363
Name:ROTICH, JOYCE (PHAM D)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:ROTICH
Suffix:
Gender:F
Credentials:PHAM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13602 LAVENDER MIST LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2609
Mailing Address - Country:US
Mailing Address - Phone:702-788-1049
Mailing Address - Fax:
Practice Address - Street 1:8386 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3428
Practice Address - Country:US
Practice Address - Phone:703-330-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist