Provider Demographics
NPI:1356657019
Name:ROACH, RHAN ELLIS (RPH)
Entity type:Individual
Prefix:MR
First Name:RHAN
Middle Name:ELLIS
Last Name:ROACH
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 1:908 TWELVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3536
Mailing Address - Country:US
Mailing Address - Phone:856-513-6393
Mailing Address - Fax:
Practice Address - Street 1:702 BROWNING LN
Practice Address - Street 2:
Practice Address - City:BROOKLAWN
Practice Address - State:NJ
Practice Address - Zip Code:08030-2645
Practice Address - Country:US
Practice Address - Phone:856-456-7141
Practice Address - Fax:856-742-9580
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI17222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist