Provider Demographics
NPI:1669451787
Name:RATHJEN, ROGER LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:RATHJEN
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 1:12633 BIRCHBROOK CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1509
Mailing Address - Country:US
Mailing Address - Phone:858-485-0221
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 601 MCCAINE BLVD
Practice Address - Street 2:BMC NORTH ISLAND
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7046
Practice Address - Country:US
Practice Address - Phone:619-545-4290
Practice Address - Fax:619-545-7973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist