Provider Demographics
NPI:1487665295
Name:ROGAN, EDWARD LIONEL (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LIONEL
Last Name:ROGAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N CALIFORNIA ST
Mailing Address - Street 2:GREEN BROTHERS PHARMACY SUITE 1-F
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6117
Mailing Address - Country:US
Mailing Address - Phone:209-948-6435
Mailing Address - Fax:209-235-0241
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:GREEN BROTHERS PHARMACY SUITE 1-F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-948-6435
Practice Address - Fax:209-235-0241
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 49685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist