Provider Demographics
NPI:1265866453
Name:ROGERS, AMBER EAVES (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:EAVES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ENON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-8659
Mailing Address - Country:US
Mailing Address - Phone:662-803-6163
Mailing Address - Fax:
Practice Address - Street 1:78 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2490
Practice Address - Country:US
Practice Address - Phone:662-726-4231
Practice Address - Fax:662-726-9006
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-12992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist