Mary Jo Laroche, R.PH.
Individual provider Active NPI Pharmacist · Bridgeport, OH
NPI 1457601239 · NPPES record last updated Sep 19, 2012
Key facts
- NPI
- 1457601239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 03221493 (OH)
- Practice address
- 56130 National Road
Bridgeport, OH 43912 - Phone
- (740) 633-3368
- Fax
- (740) 633-3438
- NPI assigned
- Sep 19, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03221493 | OH | MD | Pharmacist |
| RP439846 | PA | MD | Pharmacist |
| RP0005926 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riesbeck Food Markets, Inc. | Past | Accepting new patients | |
| Riesbeck Food Markets, Inc. | Pharmacist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03221493 | OH | Yes |
| Pharmacist | 183500000X | RP439846 | PA | |
| Pharmacist | 183500000X | RP0005926 | WV |
Addresses
Primary practice location
56130 National Road
Bridgeport, OH 43912
Mailing address
P.O. Box 622
70239 Central Avenue
Barton, OH 43905
Phone (740) 359-1386
Other providers in Bridgeport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.