Provider Demographics
NPI:1679619027
Name:ROGAN, SR, DEAN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:L
Last Name:ROGAN, SR
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62976-0068
Mailing Address - Country:US
Mailing Address - Phone:618-342-6806
Mailing Address - Fax:618-342-6241
Practice Address - Street 1:201 E COMMERCIAL
Practice Address - Street 2:BOX 241
Practice Address - City:PULASKI
Practice Address - State:IL
Practice Address - Zip Code:62976-0241
Practice Address - Country:US
Practice Address - Phone:618-342-6737
Practice Address - Fax:618-342-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5129652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist