Provider Demographics
NPI:1659976587
Name:ROGERS, MARIE (CPHT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 5TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:ND
Mailing Address - Zip Code:58785-7169
Mailing Address - Country:US
Mailing Address - Phone:701-720-7061
Mailing Address - Fax:
Practice Address - Street 1:400 BURDICK EXPY E
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDTECH778183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician