Provider Demographics
NPI:1467093211
Name:ROGERSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:ROGERSVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-335-2310
Mailing Address - Street 1:16135 HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-8118
Mailing Address - Country:US
Mailing Address - Phone:256-444-7777
Mailing Address - Fax:256-607-7112
Practice Address - Street 1:16135 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8118
Practice Address - Country:US
Practice Address - Phone:256-444-7777
Practice Address - Fax:256-607-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy