Provider Demographics
NPI:1659968428
Name:ROGERS, KELLY G (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11409 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1023
Mailing Address - Country:US
Mailing Address - Phone:913-963-2693
Mailing Address - Fax:
Practice Address - Street 1:22210 W 66TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3521
Practice Address - Country:US
Practice Address - Phone:913-422-2134
Practice Address - Fax:913-422-2138
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist