Provider Demographics
NPI:1619150794
Name:ROGOFF, MICHAEL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:ROGOFF
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 1:23001 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2110
Mailing Address - Country:US
Mailing Address - Phone:718-528-8585
Mailing Address - Fax:718-525-6907
Practice Address - Street 1:23001 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2110
Practice Address - Country:US
Practice Address - Phone:718-528-8585
Practice Address - Fax:718-525-6907
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist