Provider Demographics
NPI:1629327549
Name:ROGERS, SHIRLEY HOWELL (PHYSICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:HOWELL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 COTTINGHAM BLVD N
Mailing Address - Street 2:SUITE #3
Mailing Address - City:BENNETSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29574-2868
Mailing Address - Country:US
Mailing Address - Phone:843-479-8355
Mailing Address - Fax:843-479-9782
Practice Address - Street 1:4005 CLEVE MAYERS CT
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574
Practice Address - Country:US
Practice Address - Phone:843-464-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist