Provider Demographics
NPI:1558379925
Name:ROGERS, SHANNON ELIZABETH (PHARMD, BCGP, BCPS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARMD, BCGP, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WEST THIRD STREET
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428-9000
Mailing Address - Country:US
Mailing Address - Phone:765-506-7100
Mailing Address - Fax:937-267-3315
Practice Address - Street 1:4100 WEST THIRD STREET
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:765-506-7100
Practice Address - Fax:937-267-3315
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12631835G0303X
IN31008571835P1200X
IN26020197A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy