Provider Demographics
NPI:1720035447
Name:M. ROGERS, INC. & SUBSIDIARY
Entity Type:Organization
Organization Name:M. ROGERS, INC. & SUBSIDIARY
Other - Org Name:ROGERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-442-5694
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491-1544
Mailing Address - Country:US
Mailing Address - Phone:660-736-5512
Mailing Address - Fax:660-736-4361
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1544
Practice Address - Country:US
Practice Address - Phone:660-736-5512
Practice Address - Fax:660-736-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0038133336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600243422Medicaid
MO0320460002Medicare ID - Type Unspecified