Provider Demographics
NPI:1295335388
Name:ROCHA, HALEY (RPH)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W YOUGHIOGHENY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:WV
Mailing Address - Zip Code:26705-8285
Mailing Address - Country:US
Mailing Address - Phone:304-698-4093
Mailing Address - Fax:
Practice Address - Street 1:1142 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1508
Practice Address - Country:US
Practice Address - Phone:304-455-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist