Provider Demographics
NPI:1255625042
Name:LAROUCHE, RENEE SUZANNE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:SUZANNE
Last Name:LAROUCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ORCHARD HILL PARK DR
Mailing Address - Street 2:T-1965
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-7020
Mailing Address - Country:US
Mailing Address - Phone:978-534-4358
Mailing Address - Fax:978-534-4358
Practice Address - Street 1:86 ORCHARD HILL PARK DR
Practice Address - Street 2:T-1965
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-7020
Practice Address - Country:US
Practice Address - Phone:978-534-4358
Practice Address - Fax:978-534-4358
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232605183500000X
NH3652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist