Provider Demographics
NPI:1265564058
Name:LAROCHE, KEITH NORMAND (RPH)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:NORMAND
Last Name:LAROCHE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-3208
Mailing Address - Country:US
Mailing Address - Phone:413-281-3810
Mailing Address - Fax:413-782-6409
Practice Address - Street 1:1105 BOSTON RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1333
Practice Address - Country:US
Practice Address - Phone:413-782-6897
Practice Address - Fax:413-782-6409
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist