Provider Demographics
NPI:1457086357
Name:ROGERS, DAVID MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
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 1:535 E WATERFRONT DR APT 7303
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-5039
Mailing Address - Country:US
Mailing Address - Phone:302-345-7454
Mailing Address - Fax:
Practice Address - Street 1:420 E WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1143
Practice Address - Country:US
Practice Address - Phone:302-345-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist