1093103335 NPI number — ROGERS PHARMACY & THE CREATIVE COMPOUNDING CENTER LLC

Table of content: DR. PAUL F DEL GIUDICE MD (NPI 1508863093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093103335 NPI number — ROGERS PHARMACY & THE CREATIVE COMPOUNDING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGERS PHARMACY & THE CREATIVE COMPOUNDING CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROGERS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093103335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPEER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-664-0600
Provider Business Mailing Address Fax Number:
810-664-3522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 W NEPESSING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-664-0600
Provider Business Practice Location Address Fax Number:
810-664-3522
Provider Enumeration Date:
01/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-664-0600

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301010618 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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