Provider Demographics
NPI:1679552178
Name:HIRSH, ROGER NELSON (RPH MS MBA)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:NELSON
Last Name:HIRSH
Suffix:
Gender:M
Credentials:RPH MS MBA
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:NAVAL MEDICAL CENTER PHARMACY
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-0246
Mailing Address - Fax:757-953-0268
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:NAVAL MEDICAL CENTER PHARMACY
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-0246
Practice Address - Fax:757-953-0268
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202005700183500000X
WI12296040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist