1720114515 NPI number — MR. W. OWEN ROGERS R.PH.

Table of content: MR. W. OWEN ROGERS R.PH. (NPI 1720114515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720114515 NPI number — MR. W. OWEN ROGERS R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
W.
Provider Middle Name:
OWEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGERS
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
OWEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720114515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9611 E MONTEREY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85209-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-354-1605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3185 W APACHE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85220-3687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-288-2728
Provider Business Practice Location Address Fax Number:
480-288-2730
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7699 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7699 . This is a "PHARMACIST LISCENSE #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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