Provider Demographics
NPI:1104847151
Name:ROGERS PHARMACY INC
Entity Type:Organization
Organization Name:ROGERS PHARMACY INC
Other - Org Name:ROGERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-243-6401
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0591
Mailing Address - Country:US
Mailing Address - Phone:870-886-5700
Mailing Address - Fax:570-886-5439
Practice Address - Street 1:221 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-2335
Practice Address - Country:US
Practice Address - Phone:870-886-5700
Practice Address - Fax:870-886-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR205303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0422371OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0422371OtherNCPDP PROVIDER IDENTIFICATION NUMBER