Provider Demographics
NPI:1467904243
Name:ROGERSON, DUSTEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTEN
Middle Name:
Last Name:ROGERSON
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 1:317 LAKE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2504
Mailing Address - Country:US
Mailing Address - Phone:530-351-7050
Mailing Address - Fax:530-351-7055
Practice Address - Street 1:317 LAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2504
Practice Address - Country:US
Practice Address - Phone:530-351-7050
Practice Address - Fax:530-351-7055
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65750OtherRPH#