Provider Demographics
NPI:1225250228
Name:BECKER, ROGER A (RPH)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:BECKER
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 1:120 GRAND HERON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2401
Mailing Address - Country:US
Mailing Address - Phone:850-233-6684
Mailing Address - Fax:850-233-0474
Practice Address - Street 1:3157 WEST 23RD STREET
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1828
Practice Address - Country:US
Practice Address - Phone:850-747-0777
Practice Address - Fax:850-747-9010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 28163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist