Provider Demographics
NPI:1497049472
Name:ROGERS, RALPH EDWARD II (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:EDWARD
Last Name:ROGERS
Suffix:II
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 1:2604 PEACH ORCHARD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2489
Mailing Address - Country:US
Mailing Address - Phone:706-849-4161
Mailing Address - Fax:706-869-0937
Practice Address - Street 1:2604 PEACH ORCHARD RD STE 300
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2489
Practice Address - Country:US
Practice Address - Phone:706-849-4161
Practice Address - Fax:706-869-0937
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH023727OtherGA RPH LICENSE NUMBER