Provider Demographics
NPI:1245513134
Name:DESROCHES, ODILIA ISABEL (PHARMD)
Entity type:Individual
Prefix:
First Name:ODILIA
Middle Name:ISABEL
Last Name:DESROCHES
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 1:168 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1546
Mailing Address - Country:US
Mailing Address - Phone:508-965-5343
Mailing Address - Fax:
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist