Provider Demographics
NPI:1780684480
Name:ROGERS, EARL M I (MS, PD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:M
Last Name:ROGERS
Suffix:I
Gender:M
Credentials:MS, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 STILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2408
Mailing Address - Country:US
Mailing Address - Phone:804-794-9541
Mailing Address - Fax:804-675-5762
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:VAMC PHARMACY SVC (119)
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5811
Practice Address - Fax:804-675-5762
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist