Provider Demographics
NPI:1598105520
Name:ROGERS, BRUCE D (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:ROGERS
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 1:1300 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6169
Mailing Address - Country:US
Mailing Address - Phone:920-426-5770
Mailing Address - Fax:920-426-1708
Practice Address - Street 1:1300 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6169
Practice Address - Country:US
Practice Address - Phone:920-426-5770
Practice Address - Fax:920-426-1708
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9799-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist