Provider Demographics
NPI:1376811919
Name:ROGERS, ANTHONY V (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:V
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 1:740 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1550
Mailing Address - Country:US
Mailing Address - Phone:773-929-1097
Mailing Address - Fax:773-929-9934
Practice Address - Street 1:740 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1550
Practice Address - Country:US
Practice Address - Phone:773-929-1097
Practice Address - Fax:773-929-9934
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361924025OtherTAX ID