Provider Demographics
NPI:1912510272
Name:ROCHE, JERRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ROCHE
Suffix:
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 1:235 MANOR BLVD APT 1607
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4191
Mailing Address - Country:US
Mailing Address - Phone:239-595-8676
Mailing Address - Fax:
Practice Address - Street 1:7301 RADIO RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6709
Practice Address - Country:US
Practice Address - Phone:239-353-2484
Practice Address - Fax:239-353-3255
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist