Provider Demographics
NPI:1750854030
Name:LABRIE, ROGER (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:LABRIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 NETTLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4650
Mailing Address - Country:US
Mailing Address - Phone:719-213-6450
Mailing Address - Fax:
Practice Address - Street 1:5136 EAGLE DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2607
Practice Address - Country:US
Practice Address - Phone:719-333-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist