Provider Demographics
NPI:1053633362
Name:RODGERS, JOHN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:RODGERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 W BLOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1121
Mailing Address - Country:US
Mailing Address - Phone:716-652-4348
Mailing Address - Fax:
Practice Address - Street 1:2261 W BLOOD RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1121
Practice Address - Country:US
Practice Address - Phone:716-652-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist