Provider Demographics
NPI:1780309385
Name:ROCCO, RALPH A (PHARMD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:ROCCO
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 1:209 STAFFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2734
Mailing Address - Country:US
Mailing Address - Phone:609-978-4923
Mailing Address - Fax:609-978-5854
Practice Address - Street 1:209 STAFFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2734
Practice Address - Country:US
Practice Address - Phone:609-978-4923
Practice Address - Fax:609-978-5854
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03734500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist