Provider Demographics
NPI:1558360792
Name:RODGERS, SUSAN V (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:V
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5915
Mailing Address - Country:US
Mailing Address - Phone:903-723-2880
Mailing Address - Fax:903-723-1910
Practice Address - Street 1:1919 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5915
Practice Address - Country:US
Practice Address - Phone:903-723-2880
Practice Address - Fax:903-723-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104627183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104627OtherSTATE PHARMACY TECH. #
TX090101208374375OtherPTCB #