Provider Demographics
NPI:1679844112
Name:RODGER, KENNETH THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:THOMAS
Last Name:RODGER
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 1:950 IMMOKALEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4800
Mailing Address - Country:US
Mailing Address - Phone:239-514-2049
Mailing Address - Fax:239-514-3549
Practice Address - Street 1:950 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4800
Practice Address - Country:US
Practice Address - Phone:239-514-2049
Practice Address - Fax:239-514-3549
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist