Provider Demographics
NPI:1508064239
Name:RODGERS, BRYAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:M
Last Name:RODGERS
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 1:113 TALLYHO WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7829
Mailing Address - Country:US
Mailing Address - Phone:270-982-1285
Mailing Address - Fax:
Practice Address - Street 1:467 N DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1306
Practice Address - Country:US
Practice Address - Phone:270-351-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist