Provider Demographics
NPI:1033273149
Name:ROGERS DRUG AND GROCERY
Entity Type:Organization
Organization Name:ROGERS DRUG AND GROCERY
Other - Org Name:ROGERS DRUG AND GROCERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:HOHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:763-428-2218
Mailing Address - Street 1:21351 JOHN MILLESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374
Mailing Address - Country:US
Mailing Address - Phone:763-428-2218
Mailing Address - Fax:763-428-4673
Practice Address - Street 1:21351 JOHN MILLESS DRIVE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374
Practice Address - Country:US
Practice Address - Phone:763-428-2218
Practice Address - Fax:763-428-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2600220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2415140OtherNCPDP