Provider Demographics
NPI:1225041874
Name:JERRY D ROGERS
Entity Type:Organization
Organization Name:JERRY D ROGERS
Other - Org Name:JERRY'S DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-547-1221
Mailing Address - Street 1:300 WALL ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-1938
Mailing Address - Country:US
Mailing Address - Phone:256-547-1221
Mailing Address - Fax:256-547-1299
Practice Address - Street 1:300 WALL ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-1938
Practice Address - Country:US
Practice Address - Phone:256-547-1221
Practice Address - Fax:256-547-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105633332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001483Medicaid
AL0799180001Medicare PIN
AL0112110Medicare UPIN
AL0799180001Medicare NSC