Provider Demographics
NPI:1710264593
Name:ROGGOW, DEBRA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:ROGGOW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 E BLUE EARTH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4226
Mailing Address - Country:US
Mailing Address - Phone:507-235-5965
Mailing Address - Fax:
Practice Address - Street 1:1123 E BLUE EARTH AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4226
Practice Address - Country:US
Practice Address - Phone:507-235-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist