Provider Demographics
NPI:1902939168
Name:LAROCCA, GRACE THERESA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:THERESA
Last Name:LAROCCA
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 1:3627 MARTHA BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3828
Mailing Address - Country:US
Mailing Address - Phone:516-433-2868
Mailing Address - Fax:
Practice Address - Street 1:325 ROUTE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4149
Practice Address - Country:US
Practice Address - Phone:631-271-2525
Practice Address - Fax:631-271-1706
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist