Provider Demographics
NPI:1760703631
Name:ROACH, RICHARD GARRETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GARRETT
Last Name:ROACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 NC HWY 102 WEST
Practice Address - Street 2:KERR DRUG #500
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513
Practice Address - Country:US
Practice Address - Phone:252-746-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist