Provider Demographics
NPI:1235607227
Name:ROGERS, RONALD ERIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ERIC
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 FERN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6233
Mailing Address - Country:US
Mailing Address - Phone:831-917-6378
Mailing Address - Fax:
Practice Address - Street 1:525 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1032
Practice Address - Country:US
Practice Address - Phone:707-443-1614
Practice Address - Fax:707-443-4461
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist