Provider Demographics
NPI:1467774992
Name:OWEN, ROGER DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DEAN
Last Name:OWEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KITTY LN
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3895
Mailing Address - Country:US
Mailing Address - Phone:540-381-0320
Mailing Address - Fax:
Practice Address - Street 1:1000 LAUREL ST NE
Practice Address - Street 2:KMART 4850
Practice Address - City:CHRISTINSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-382-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist