Provider Demographics
NPI:1720264021
Name:LAROQUE, MARIE E (RPH)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:LAROQUE
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 1:97 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5244
Mailing Address - Country:US
Mailing Address - Phone:845-562-1814
Mailing Address - Fax:
Practice Address - Street 1:97 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5244
Practice Address - Country:US
Practice Address - Phone:845-562-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01953828Medicaid
NY6054310001Medicare NSC