Provider Demographics
NPI:1285099432
Name:PLOCH, STEPHEN (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:PLOCH
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 1:9610 FM 1097 RD W
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-4998
Mailing Address - Country:US
Mailing Address - Phone:936-856-4096
Mailing Address - Fax:
Practice Address - Street 1:4870 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4280
Practice Address - Country:US
Practice Address - Phone:936-760-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist