Provider Demographics
NPI:1669077715
Name:LANDROCHE, THEODORE CHARLES II (PHARMD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:CHARLES
Last Name:LANDROCHE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5341
Mailing Address - Country:US
Mailing Address - Phone:207-892-8571
Mailing Address - Fax:
Practice Address - Street 1:797 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:NORTH WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5341
Practice Address - Country:US
Practice Address - Phone:207-892-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist