Provider Demographics
NPI:1346790227
Name:ROGERS, MICHELLE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5339
Mailing Address - Country:US
Mailing Address - Phone:800-995-4363
Mailing Address - Fax:800-985-4363
Practice Address - Street 1:5710 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5339
Practice Address - Country:US
Practice Address - Phone:800-995-4363
Practice Address - Fax:800-985-4363
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26109OtherFL PHARMACIST LICENSE #