Provider Demographics
NPI:1750024865
Name:FLAUTT, ROGER THOMAS
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:THOMAS
Last Name:FLAUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-345-9761
Mailing Address - Fax:740-345-5459
Practice Address - Street 1:57 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-345-9761
Practice Address - Fax:740-345-5459
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213120183500000X
OH03-2-13120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist