Provider Demographics
NPI:1194183467
Name:M ROGERS INC & SUBSIDIARY
Entity Type:Organization
Organization Name:M ROGERS INC & SUBSIDIARY
Other - Org Name:ROGERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-562-2300
Mailing Address - Street 1:125 E SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2669
Mailing Address - Country:US
Mailing Address - Phone:660-562-2300
Mailing Address - Fax:660-224-0259
Practice Address - Street 1:125 E SOUTH AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2669
Practice Address - Country:US
Practice Address - Phone:660-562-2300
Practice Address - Fax:660-224-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20150449103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157902OtherPK