Provider Demographics
NPI:1548391329
Name:FITZPATRICK, ROGER B (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:B
Last Name:FITZPATRICK
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 1:4215 W 1050 S
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6034
Mailing Address - Country:US
Mailing Address - Phone:801-600-6113
Mailing Address - Fax:
Practice Address - Street 1:580 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1733
Practice Address - Country:US
Practice Address - Phone:801-773-8703
Practice Address - Fax:801-773-9628
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT147395-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist